Asthma at 60? Yes, it’s pos­si­ble

Cape Breton Post - - Advice/Games - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: I am a fit and healthy 60-year-old male. Re­cently I was trou­bled by a se­ries of es­ca­lat­ing symp­toms: I oc­ca­sion­ally got a bit of hoarse­ness, then I seemed to lose some ca­pac­ity in my lungs. When breath­ing hard, it seemed I could bring air into only the top of my lungs, not take a deep breath. I then be­gan wheez­ing when ex­ert­ing my­self, and my throat and chest be­gan to feel mild pres­sure, like some­one was gen­tly push­ing on them. My en­ergy was low.

The wheez­ing and hoarse­ness con­tin­ued, and I went to my doc­tor. He or­dered an X-ray of my chest and si­nus, which were nor­mal. We agreed that I would try a bron­chodila­tor (Salbu­ta­mol). One puff af­ter a slightly wheez­ing walk up­hill gave me im­me­di­ate relief. I felt like my old self again, and my voice re­turned to nor­mal.

But the symp­toms came back the next day. I used an­other puff, which opened my air­ways enough that I had a great bike ride home. De­spite the suc­cess of the Salbu­ta­mol, I would like to get to the source of the breath­ing dif­fi­cul­ties, not just treat the symp­toms. I have an ap­point­ment with a spe­cial­ist for lung func­tion tests. Do you have any sugges­tions or ad­vice? -J.U.

AN­SWER: It sounds very much like you have asthma. Many peo­ple are un­der the mis­taken im­pres­sion that asthma comes on only dur­ing child­hood or ado­les­cence, but it is just as likely to do so in a per­son’s 60s. As far as un­der­stand­ing the un­der­ly­ing cause, that is be­yond med­i­cal sci­ence right now.

How­ever, we do know a lot about the un­der­ly­ing in­flam­ma­tion that is associated with asthma. What I can say is that af­ter the di­ag­no­sis is con­firmed, prob­a­bly by the lung func­tion tests show­ing air­way ob­struc­tion that is re­versible with treat­ment, you may need an anti-in­flam­ma­tory, such as an in­haled steroid. This is ap­pro­pri­ate ther­apy for most peo­ple with asthma that is more than in­ter­mit­tent and mild.

The book­let on asthma and its con­trol ex­plains this ill­ness in de­tail. Read­ers can ob­tain a copy by writ­ing: Dr. Roach , Book No. 602, 628 Vir­ginia Dr., Or­lando, FL 32803 En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

DEAR DR. ROACH: I am a 75-year-old male with high blood pres­sure. My high blood pres­sure is con­trolled (130 to 140/75), but I would like to in­clude thi­azide in my treat­ment. I have a his­tory of a Stevens-Johnson re­ac­tion to sulfa an­tibi­otics. My re­ac­tion was never for­mally di­ag­nosed, but the mu­cosal peel­ing was strongly sug­ges­tive. I have asked sev­eral doc­tors if there is a skin test to rule out an al­lergy to sulfa, to no avail. Is there a skin test avail­able to di­ag­nose an al­lergy to sulfa, and is it safe to take a thi­azide di­uretic in face of a sulfa al­lergy? -- C.O.

AN­SWER: Stevens-Johnson syn­drome is a se­vere skin re­ac­tion to med­i­ca­tion or in­fec­tion. The re­ac­tion in­cludes blis­ter­ing of the skin, and, as you state, it usu­ally in­volves the mouth and eyes. In the most se­vere cases, much or all of the skin peels and sheds, and the per­son is in grave danger of death from in­fec­tion, fluid loss and or­gan fail­ure. You should never take any sulfa an­tibi­otic again or a closely re­lated drug, such as sul­fasalazine or sul­fac­etamide.

There is no re­li­able skin test for this re­ac­tion.

Thi­azide and loop di­uret­ics (such as furosemide) chem­i­cally are some­what re­lated to sulfa an­tibi­otics. How­ever, the like­li­hood of you de­vel­op­ing a re­ac­tion is ex­tremely small. I could find only four cases in the world’s lit­er­a­ture, and it’s not clear that there is true cross-re­ac­tiv­ity.

None­the­less, be­cause there are many other choices, my ex­pe­ri­ence is that most physi­cians would be un­will­ing to give you a thi­azide di­uretic. Why take the chance, even if the chance is very small? There are other di­uret­ics avail­able that are not re­lated to sulfa at all.

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