DEAR DR. ROACH: I’m a 73-year-old male with power obstructive pulmonary illness (COPD). I just about have it beneath management with treatment, however I’m nonetheless not capable of do a complete lot, as I really feel shortness of breath simply. However, that isn’t my principal drawback! I’ve a dry mouth from the treatment I’m taking for it. I’m taking Stiolto Respimat inhalation spray.
I’ve tried toothpastes, mouthwashes, sugar-free lemon drops, gargles, and many others. Nothing helps. I’m having many dental issues as a result of this dry mouth, and my dentist informed me that it’ll proceed, as it’s brought on by the treatment I’m taking for COPD. Is there any assist for this dry mouth? I’m determined to get this beneath management and save my enamel. — J.C.
ANSWER: Power obstructive pulmonary illness is an especially widespread situation in North America. The main symptom is shortness of breath, and the most certainly trigger is smoking, though there are less-common causes.
Inhaled medicines are the first-line therapy for COPD. These are sometimes comprised of a mix of a medication to open airways (a bronchodilator, however generally a long-acting formulation is utilized in individuals with COPD, besides these with very delicate COPD) together with an inhaled anticholinergic drugs, additionally referred to as an antimuscarinic.
Antimuscarinics additionally open up the airways, however via a distinct mechanism. The Stiolto you are taking is a long-acting bronchodilator (olodaterol) and a long-acting antimuscarinic (tiotropium). These two medicines work very properly collectively and are generally co-prescribed.
It’s the tiotropium that generally causes dry mouth. Most individuals have delicate dry mouth signs, however extreme dry mouth is an actual drawback, each to your high quality of life, but in addition to your enamel, as you accurately level out. You could have tried most of the first-line remedies for dry mouth. Though there are mouth lubricants you need to use, I feel it could make extra sense to strive a distinct anticholinergic drug that’s much less more likely to trigger dry mouth.
The newer brokers, similar to aclidinium, have a lot much less dry mouth signs than the tiotropium within the Stiolto you’re taking. Utilizing one drugs to counteract the uncomfortable side effects of one other treatment is typically mandatory; nevertheless, it could be potential so that you can get the identical reduction as you obtain along with your present therapy, however with fewer uncomfortable side effects in case you swap medicines.
DEAR DR. ROACH: Are you aware if there have been any developments within the therapy of arachnoiditis?
My finest good friend obtained this analysis final week following an epidural steroid injection for again ache in February. She takes naproxen, Tylenol 3, and Lyrica. She says that Lyrica offers reduction from extreme nerve ache. It’s unhappy that she went in for ache reduction and ended up with this life-changing analysis. Thanks to your assist. — J.B.
ANSWER: Arachnoiditis is a kind of meningitis, one that could be brought on by an adversarial response to the medicines used for an epidural steroid injection. I have no idea of any remedy for arachnoiditis. The situation is handled with ache medicines of the kind she is getting, and solely sometimes with surgical procedure in individuals with very disabling signs. Some individuals get barely higher over time, whereas others can worsen. It is a uncommon and really unlucky consequence. Epidural injections are normally protected, however shouldn’t be undertaken evenly.
Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column each time potential. Readers might e-mail inquiries to [email protected] or ship mail to 628 Virginia Dr., Orlando, FL 32803.
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