Dear Dr. Roach: I found your response to a question about shortness of breath in a recent column very interesting, since I had the problem for a couple of years before the cause was identified. I had been to an oncologist, cardiologist and family practice, and had all proper tests and X-rays with no answers. The answer was found at the eye doctor. I had been prescribed Combigan eyedrops for pressure in the eye. I have asthma and should not have been prescribed this drug. Since I stopped taking the eyedrops, my breathing is slowly returning to normal. It was very frustrating because all physicians had a complete drug list but never picked up on it.
Combigan is an eyedrop that contains a beta blocker. Beta blockers are effective treatment for elevated eye pressure, which is the major risk factor for glaucoma. Enough of the beta blocker can be absorbed into the system that sometimes people can experience side effects. The most common ones are exacerbation of asthma and slow heart rate.
Medicines that stimulate the beta receptors (like albuterol) open up the airways, while those that block the beta receptors can close them. Usually people experience wheezing or coughing that gives a clue to the reason for the shortness of breath, but not always. Similarly, the heart rate can drop into the 40s in people taking beta blocker drops. I am glad your eye doctor figured it out.
Dear Dr. Roach: I would be interested in your thoughts regarding the use of Botox injections or stents to relieve the effects of BPH.
BPH is benign prostatic hyperplasia — enlargement of the prostate gland. It is nearly universal in older men. Its symptoms vary, but often it causes difficulty in urinating. First line treatment is usually medication, but for men who don’t do well or can’t take medication, there are a variety of surgical options. These include lasers, and heating and freezing the prostate tissue. Botox and stenting have been evaluated as additional options.
Botulinum toxin (Botox and others) paralyzes muscles for a prolonged period. Because the prostate has muscle tissue (a special kind of muscle called smooth muscle), botulinum toxin has been tried and initially seemed effective. However, two large trials randomized men to botulinum toxin versus saline, where neither the doctor nor the patient knew what they were getting. The results showed that saline was just as effective. Botulinum toxin has not gotten much attention since, though it may still be useful in some men who can’t tolerate other options.
A urethral stent is a plastic or metal tube placed in the part of the urethra that goes through the prostate gland. In theory, these hold the urethra open and make it easier to urinate. While studies have shown benefit, not everyone had a good outcome. The stent may become dislodged or infected, and about a third of men needed to have the stents removed, which often proved difficult. Efforts continue to find better materials and techniques, but at this writing, urethral stenting is not the best option for most men with BPH.
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 [email protected]
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