How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. Phil, MD Your Own Question
Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 57190
Experience:  GP in the United States
55099014
Type Your Medical Question Here...
Dr. Phil, MD is online now

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: 1 year ago.
Category: Medical
Expert:  Dr. Phil, MD replied 1 year ago.

are you a smoker?

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

Customer: replied 1 year 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 1 year 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 1 year 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.

if done for now, please leave a positive rating above the chat box so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me with "a question for Dr. Phil" in the medicine, cardiology or pharmacy categories if you have any other questions

here is my website if you need to reach me again:

http://www.justanswer.com/medical/expert-irondoc/

Thanks for using justanswer.com

Customer: replied 1 year 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 1 year 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 1 year ago.
I agree but would they reverse an obstruction(swelling) that occurred in the last month
Expert:  Dr. Phil, MD replied 1 year ago.

Yes

Customer: replied 1 year 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 1 year ago.

No, I would use the minimal dose possible

the steroids can have nasty side effects over time

Customer: replied 1 year 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 1 year ago.

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

this will have no side effects

and go from there

Customer: replied 1 year 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 1 year 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 1 year ago.

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

Customer: replied 1 year 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 1 year ago.

yes

Customer: replied 1 year 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 1 year 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 1 year 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 1 year ago.

any time

Customer: replied 1 year 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 1 year ago.

That is not correct.

the steroids will act at any time

Customer: replied 1 year 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 1 year ago.

bingo

Customer: replied 1 year ago.
do inhaled steroids offer the same reversibility?
Expert:  Dr. Phil, MD replied 1 year ago.

No. They will maintain as you suggested

Dr. Phil, MD and other Medical Specialists are ready to help you
Customer: replied 1 year ago.
Thanks