I am P.K.Banerji 73yrs, male with moderate hypertension under control with diuretics & telmesartan, symptomatic bifascicular bloc under dual chamber PPM. Non diabetic & was a heavy smoker - stopped more than 10 yrs back . Now having COPD with occasional acute exacerbations- under nebuliser 2 to 3 times/ day & MDI inhalation of salmetorol & fluticasone + bronchodialators. I need your suggestions for better effort tolerance.

Dr. Satyadeo ChoubeyPulmonologist8yrs exp

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Thanks for your query. First be sure that your symptoms are not due to heart problem. If it is COPD in acute exacerbation not controlled on enough doses of bronchodilators, you may be needing a short course 7-10 days of oral steroid. Get a arterial blood gas analysis done. If carbon dioxide is rising, you may require non invasive ventilation like tiotropium. Once stable add inhaler tiotropium once daily to your medication. Best wishes.  

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