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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54806
Experience:  GP in the United States
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I've just done a I've had repeated chest infections last 6

Resolved Question:

Hi
I’ve just done a
I’ve had repeated chest infections for the last 6 months so I had a PFT done about 3 months ago and everything was normal.
However I continued to have chest infections so I bough a home lung monitor and have been monitoring my lung function for the last month
About 3 to 4 weeks ago my FEV1 started to drop so I had a PFT done and my readings are FEV1 98% and fev1/fvc=69 so I’m borderline obstructive.
Considering my decline is recent would it be a good idea to go on a course of steroids now as the swelling in my lungs is a most a month old and my respond to treatment before it becomes ironic
Age 42 male
Submitted: 11 months ago.
Category: Medical
Expert:  Dr. Phil, MD replied 11 months ago.

are you a smoker?

do we know what is causing this decline in lung function?

Customer: replied 11 months ago.
Stopped smoking 5 years ago, but about two years ago my doctor noticed me wheezing so he put me on Relvar 92/22. Then about 5 weeks ago I did a Methacholine challenge test and it indicated I do not have asthma, so I stayed off my inhaler for a few weeks and my breathing got worse and I got another chest infection.
Customer: replied 11 months ago.
I'm back on the inhaler now but I seem to have lost lung function in the last month about 300ml
Expert:  Dr. Phil, MD replied 11 months ago.

Thanks. These chest "infections" are likely COPD exacerbations.

you qualify for mild COPD.

I would recommend you get on a stronger inhaler to prevent this

Go with advair 250/50 1 puff twice a day

let me know if you have other questions.

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Customer: replied 11 months ago.
Considering my decline is recent would it be worth my while going on a course of steroids before the lung obstruction (swelling ) becomes permanent. I feel I have window to reverse some of the obstruction now
Expert:  Dr. Phil, MD replied 11 months ago.

Steroids will not permanently help anything. They are only a temporary fix.

If you are in bad shape, I would go on them but it won't stop anything

Customer: replied 11 months ago.
I agree but would they reverse an obstruction(swelling) that occurred in the last month
Expert:  Dr. Phil, MD replied 11 months ago.

Yes

Customer: replied 11 months ago.
For the first time in my life I took steroids Deltacortril on the mid March (5 days at 30mg per day followed by 5 days at 15mg per day). All symptoms cleared up. Then I repeated the dose in early May (5 days at 30mg per day followed by 5 days at 15mg per day) again all symptoms cleared up. Now after a poor PFT I'd like to try the same dose again to reverse a recent obstruction(swelling) or should I ask for a higher dose?
Expert:  Dr. Phil, MD replied 11 months ago.

No, I would use the minimal dose possible

the steroids can have nasty side effects over time

Customer: replied 11 months ago.
i do worry about the side effects, if I take another course that will be two 10 day courses in 1 month however if the second 10 day course reverses or partially reverses a recent obstruction it might be worth it because it I don't take the steroids now the obstruction will become permanent and not even partially reverse. Note I'm also on the Relvar inhaler.
What do you think?
Expert:  Dr. Phil, MD replied 11 months ago.

I think you should take a very short burst. 5 days

this will have no side effects

and go from there

Customer: replied 11 months ago.
Do you mean 5 days at 30mg per day and a weaning period of 15mg for say 4 days?
Expert:  Dr. Phil, MD replied 11 months ago.

No. If you only take for 5 days you don't need to wean. Just 30 mg for 5 days

Expert:  Dr. Phil, MD replied 11 months ago.

please don't forget a positive rating. I appreciate it

Customer: replied 11 months ago.
Ok so I start my steroids on Tuesday that will be roughly a month to 6 weeks after my exarbation they should still be effective
Expert:  Dr. Phil, MD replied 11 months ago.

yes

Customer: replied 11 months ago.
OK I picked up a perscription for 6 (30mg)tablets for 3 days, followed by 5 (25mg)tablets for 2 days,followed by 4 (20mg)tablets for 2 days, followed by 3 (15mg)tablets for 2 days, followed by 2 (10mg)tablets for 2 days, followed by 1 (5mg)tablets for 2 days. 12 days in total. Maybe I just stick with 30mg for 5 days what do you think?
Expert:  Dr. Phil, MD replied 11 months ago.

That would be fine. I would do that

please don't forget a positive rating. It is the only way I am credited for my work

Customer: replied 11 months ago.
I'll do that by the way how long after an exacerbation would steroids have any affect in reducing swelling 1 month, 2 months or more?
Expert:  Dr. Phil, MD replied 11 months ago.

any time

Customer: replied 11 months ago.
from what I read the inhaled steroids will just maintain your condition just keep your FEV1 at 85% for example, but the oral steroids are used to improve it say move it back to 90% if it was 90% before the exarbation for example. However you need to act with the steroids quickly, they become less effective with time. So for example after a year they might do nothing but within a few days they are effective but less effective as time goes on but they will still have some effect after 2 months
Expert:  Dr. Phil, MD replied 11 months ago.

That is not correct.

the steroids will act at any time

Customer: replied 11 months ago.
ok so if the exacerbation is reversible, it is as reversible with oral steroids treatment after 2 months as it would be with oral steroid treatment after 2 days?
Expert:  Dr. Phil, MD replied 11 months ago.

bingo

Customer: replied 11 months ago.
do inhaled steroids offer the same reversibility?
Expert:  Dr. Phil, MD replied 11 months ago.

No. They will maintain as you suggested

Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54806
Experience: GP in the United States
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Customer: replied 11 months ago.
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