### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
hi.........m a doc from west bengal, india. my father is suffering from severe respiratory distress 4m last 5 months....he was a chronic smoker bt not for last 3 yrs before he developed resp distress limiting his daily activities. he was primarily diagnosed to have PAH along with COPD nd was prescribed sildenafil when he developed hemoptysis 5 months ago...not relived nd was added bosentan...again it failed to correct hemoptysis,nd the dyspnoea aggravates. he was admitted here under at burdwan medical college.west bengal india..where i m persuing MD. treated wid various antibiotics bt all went in vain.Rather he developed new onset lower lobe consolidation (lt)along with the pre-existing rt lower lobe. his spo2 goes beyond 71% nd is on LTOT for last 3 months. he was given ANTI TUBERCULAR DRUGS empirically for his B/L consolidation. at present neither his saturation nor his dyspnoea at rest is improving rather it detoriates time to time....WHAT SHOULD I DO NOW?

### output:

Hello Thank you for trusting Chat Doctor Dear friend sorry to hear about your father health status. What about echo findings?? Pulmonary hypertension mild, moderate or severe? What about Ra, RV? How much EF??? Weather he is intubated??? What is platelet count and pt/in?? What about leukocyte count?? Possible causes for hemoptysis?? 1.infection (it may be pneumonia, pulmonary tb, or aspergilli or paragons) 2.bronchiectasis???3.pulmonary embolism?? 4.ft with dilapidated Ra and RV with TR with invective endocarditis?? With septic thrombus?? Advice :HRC, D-dimer, sputum culture, blood culture pt /INR, platelet count, USG chest. Treatment :1. If blood pressure normal you can add amlodipine. 2. You can add prostaglandin analog epoprostenol and treprostinil(use nor a Chat Doctor. Increase antibiotic reach to area by reducing pulmonary artery resistance 4.add metro or clindamycin if you think he developed aspirated pneumonia. Use ninefold with meropenam. Thank you