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Inhaler causing mood change? Update and more ?s in #34.


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Okay, my dd9 has been using an inhaler for three days. After she uses it, especially in the morning and night, she becomes really grumpy. It seems to settle down after awhile but there has been crying and yelling with minimal triggers. Right now she's screaming because she didn't like the taste of her antibiotic. Not quite normal for her.

 

ETA: I'm waiting for a call back from the doctor. I just called the pharmacist and she explained why the inhaler could be causing this by increasing her heart rate and making her feel agitated. She says it will pass but gave me the name of an alternative inhaler that would be better. All the full clean and dirty laundry in baskets in my room have been thrown all over and into the hall. This is not like dd AT ALL. When she's upset she gets quiet and finds a place to retreat. I'm feeling really stressed myself right now.

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Maybe. I use an albuterol inhaler. I feel jittery and...uncomfortable? after I use mine unless I go straight into exercising. Which is what I normally do because I have exercise induced and only use it before or during exercise. But occasionally I get interrupted and can't immediately start my workout and I definitely feel the effects of the inhaler. I'm sensitive to medications though.

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Poor baby. It's not how she wants to feel. Poor you, too!

 

My DS does not react that way to inhalers, but I have read that it's possibe. You might call the doc to see if there's an alternative inhaler option.

 

I feel your pain. DS reacts similarly to other meds, so I've seen the havoc. Not fun. For any of you! In fact, we are waiting on a scrip for antibiotic as they try to find one sans red dye (why oh why is there red dye in white pills?)... Because red dye is one of DS's triggers (confirmed via allergist, not just anecdotal here).

 

Hopefully your doc can call in an alternative!

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What's in the inhaler?  Albuterol will raise the heart rate but it doesn't usually cause mood changes around here (I suppose it could).  Steroids, on the other hand, are well known for causing mood changes, but typically oral rather than inhaled.  (*sigh* everything's connected...)

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According to ds20 - yes. He hates when he needs to use an inhaler or nebulizer. A few weeks ago he had an upper respiratory virus and the doctor recommended he use albuterol as part of his treatment. He said it made him very agitated, shakey and grumpy/irritated. He was really not a happy person for a bit after use. 

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Poor baby. It's not how she wants to feel. Poor you, too!

 

My DS does not react that way to inhalers, but I have read that it's possibe. You might call the doc to see if there's an alternative inhaler option.

 

I feel your pain. DS reacts similarly to other meds, so I've seen the havoc. Not fun. For any of you! In fact, we are waiting on a scrip for antibiotic as they try to find one sans red dye (why oh why is there red dye in white pills?)... Because red dye is one of DS's triggers (confirmed via allergist, not just anecdotal here).

 

Hopefully your doc can call in an alternative!

 

The pediatrician just called and doesn't think an alternative will really help the problem. I don't know how I feel about that. She did give me permission to stop if dd doesn't seem like she needs it, and agreed with trying one puff instead of two.

 

I guess the effect ran its course because now she is quiet. I know she's going to feel terrible about the mess she caused.

 

The doctor had already ordered an antiobiotic in pill form and I'm going to pick that up and give it to her tonight in order to avoid any problems with taking the taste of the liquid setting her off again.

 

I think I'll take a quick shower to de-stress and then have some bonding time.

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According to ds20 - yes. He hates when he needs to use an inhaler or nebulizer. A few weeks ago he had an upper respirator virus and the doctor recommended he use albuterol as part of his treatment. He said it made him very agitated, shakey and grumpy/irritated. He was really not a happy person for a bit after use. 

 

Thanks for sharing this.

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What's in the inhaler?  Albuterol will raise the heart rate but it doesn't usually cause mood changes around here (I suppose it could).  Steroids, on the other hand, are well known for causing mood changes, but typically oral rather than inhaled.  (*sigh* everything's connected...)

 

Yes, it's albuterol.

 

I'm a nut on prednisone. I hope I never have to take it again. I remember having to walk around and around my van in the driveway to burn off the energy. Every morning when I took it, I'd have to prepare myself for the emotional crash I'd have in the afternoon. No fun at all.

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Yes. Tho they are a very different class of steroids, they are steroids. But they should still be used bc they are also the best primary treatment available.

 

Common side effects are:

 

Side effects of systemic steroids can include weakness, acne, weight gain, mood or behavior changes, upset stomach, bone loss, eye changes, and slowing of growth. These side effects rarely occur with short-term use, such as for an acute asthma attack.

Weakness in my house means we just feel sooo tired and want a nap. Which can make anyone cranky too.

I get mild headaches and feel a bit queasy for several hours. None bad enough to ruin the day as much as an asthma attack, but most people feel a bit cranky when they are just trying to get through their day and don't feel very good.

 

For daily use, many of these side effects can be mitigated by a good diet and vitamin/mineral/oils supplements and timing the daily dose better. (For example, first thing in the morning when waking up gives them some time to level out before jumping into their day while feeling the worst. And about 30-60 minutes BEFORE an event that usually calls for it. (Such as before swimming or going hiking.). And at least 4 hours before bed. A good night of sleep does wonders for most people's mood and it's hard to sleep well shortly after an inhaler hit.

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Albuterol--totally; regular maintenance inhalers, not as much.

 

Does she need two puffs of albuterol? Are you using a peak flow meter?

 

We have a peak flow meter we got last year but I can't find it. I don't think she really needs two puffs. She's nine and that's the same amount my five foot nine inch solidly built oldest uses.

 

Now that I have to re-organize my bedroom after the "event" maybe I'll find the peak flow meter. It was kept in there last winter.

 

I've already opened a bag of Hershey's kisses to recover.

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Yes. Tho they are a very different class of steroids, they are steroids. But they should still be used bc they are also the best primary treatment available.

 

Common side effects are:

 

 

Weakness in my house means we just feel sooo tired and want a nap. Which can make anyone cranky too.

I get mild headaches and feel a bit queasy for several hours. None bad enough to ruin the day as much as an asthma attack, but most people feel a bit cranky when they are just trying to get through their day and don't feel very good.

 

For daily use, many of these side effects can be mitigated by a good diet and vitamin/mineral/oils supplements and timing the daily dose better. (For example, first thing in the morning when waking up gives them some time to level out before jumping into their day while feeling the worst. And about 30-60 minutes BEFORE an event that usually calls for it. (Such as before swimming or going hiking.). And at least 4 hours before bed. A good night of sleep does wonders for most people's mood and it's hard to sleep well shortly after an inhaler hit.

 

Yeah, and the doctor told us to use it before bed and we had issues each night. Last night she started up with me so I had dh take her to hang out downstairs with him. But he said, she wouldn't talk to him and rolled up on the floor, where he covered her with a blanket.

 

The good thing is that she's not waking up in the middle of the night crying which she had been doing before the inhaler. Her color is better, too. But that could be the antibiotics kicking in.

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Yeah, and the doctor told us to use it before bed and we had issues each night. Last night she started up with me so I had dh take her to hang out downstairs with him. But he said, she wouldn't talk to him and rolled up on the floor, where he covered her with a blanket.

 

The good thing is that she's not waking up in the middle of the night crying which she had been doing before the inhaler. Her color is better, too. But that could be the antibiotics kicking in.

Kids with asthma often have trouble sleeping and don't know why. Turns out not getting enough oxygen makes it hard for the body to sleep well. ;) coughing, cranky, sleeping more but being tired bc it isn't quality sleep, lack of weight gain or weight loss, concentration problems, chest pain that seems to have no cause - these are all often signs of asthma that are commonly over looked because people associate asthma with gasping for air TV plot stories. Truth is, it looks a LOT more subtle than that most of the time and that's why so many people don't maintain treatment too. "I feel fine, I'm just tired not struggling to breathe." But the body usually shows signs of needing more air or better circulation way before it gets to the point of gasping for air.

 

Anyways. The lack of sleep/weight gain/growth is why many drs say to use the inhaler before bed. That and too many of them aren't used to actually taking care of a kid hyped on inhaler at midnight, so they don't think about it. If it doesn't make her nauseated, I'd give her something to eat like a peanutbutter sandwich and see if the combo helps her level out enough to go to sleep quicker. For years we stayed up with a toddler and preschooler who needed a nebulizer treatment 4 times a day, one before bed. He stayed up late, but he did sleep better.

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Does she have a spacer for her inhaler? Some children find having a spacer helpful, some don't.

 

Also there are albuterol tablets and I used to take those instead of the inhaler eventhough I had both with me.

 

Yes. She's using the spacer. 

 

That's interesting about the tablets. My oldest is a singer and her voice teacher told her the inhalers can irritate the throat and to use a disk (sp?) instead. The tablets might be an option for her.

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Okay, my dd9 has been using an inhaler for three days. After she uses it, especially in the morning and night, she becomes really grumpy. It seems to settle down after awhile but there has been crying and yelling with minimal triggers. Right now she's screaming because she didn't like the taste of her antibiotic. Not quite normal for her.

 

ETA: I'm waiting for a call back from the doctor. I just called the pharmacist and she explained why the inhaler could be causing this by increasing her heart rate and making her feel agitated. She says it will pass but gave me the name of an alternative inhaler that would be better. All the full clean and dirty laundry in baskets in my room have been thrown all over and into the hall. This is not like dd AT ALL. When she's upset she gets quiet and finds a place to retreat. I'm feeling really stressed myself right now.

 

Whoops! "Liked" your post instead of quoting you. Sorry!

 

Ah, albuterol. You know how Wyle E Coyote's legs trembled when he took those Acme Energy Pills in the old cartoons? Well, that's how I feel when I take albuterol. And feeling that way for days could make anyone grumpy! I think the alternative inhaler your doctor was talking about was Xopenex (levalbuterol.) I have used it, but it doesn't seem to make much of a difference. (And iirc, it's not available in a generic form, so it is more expensive.)

 

I hope your dd gets some relief soon!

 

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Okay, my dd9 has been using an inhaler for three days. After she uses it, especially in the morning and night, she becomes really grumpy. It seems to settle down after awhile but there has been crying and yelling with minimal triggers. Right now she's screaming because she didn't like the taste of her antibiotic. Not quite normal for her.

 

ETA: I'm waiting for a call back from the doctor. I just called the pharmacist and she explained why the inhaler could be causing this by increasing her heart rate and making her feel agitated. She says it will pass but gave me the name of an alternative inhaler that would be better. All the full clean and dirty laundry in baskets in my room have been thrown all over and into the hall. This is not like dd AT ALL. When she's upset she gets quiet and finds a place to retreat. I'm feeling really stressed myself right now.

When I was on breathing treatments/inhalers, I became very weepy and emotional. It can certainly do it. Gotta love that albuterol. 

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I found a broken bar of dark chocolate in the mess and ate it because it was still wrapped. That eased the stress so I can now stay away from the open bag of kisses.

 

My room is already looking better than it has in recent weeks. But I still haven't found the peak flow meter.

 

Dd is eating fruit cocktail and happily downloading books form the library website--something by Jules Verne and one of the Diary of a Wimpy Kid books. Not all bad, I guess.

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Glad she is feeling better today.  DS (11 yrs)  hates when he reacts to meds that way - such an out of control feeling, he says it feels like someone else in his body.   :(  He sends sympathy to your DD.  

 

That's very nice. Please tell your ds, thank you. He describes what dd went through very well.

 

She at three small croissants and is now moving on to oatmeal. She wouldn't go for the zucchini.

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 My oldest is a singer and her voice teacher told her the inhalers can irritate the throat and to use a disk (sp?) instead. The tablets might be an option for her.

 

I hate the taste of the inhaler and it makes me feel nauseous so my doctor gave me the tablets as well.  Also the tablets are less obvious than the inhaler for social reasons.   Link is to information on the tablets

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=87b8cd3c-2849-4b50-b63e-9ea379165c07

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Ds uses and albuterol inhaler as needed.  He has a maintenance inhaler he takes daily.  When he was on QVAR we had no problems but he outgrew the dosage so was switched to Advair.  Holy Hannah!  Within 3 weeks he turned into the incredible rage child.  It was so bad that he was asked to leave 3 of his activities in one day.  This was so out of character that I called the pulmonary doctor and found out that it is a side effect of Advair because Advair has a long acting albuterol in it and it was causing the rage.  We discontinued the Advair and started on another med and have had no problems.  My (mostly) sweet boy is back.  There is still a little grumpiness with the albuterol inhaler but it is only for a very short span of time. 

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Is she on the inhaler permanently or just till a sickness clears?  I had an inhaler for my pneumonia/bronch bout, and it made me jittery, yes.  But the effect was so good (opening my breathing, wow) that you might just give her something to calm the jitters and get her through it.  Did he give her anything to help her sleep?  I was on a codeine cough syrup that whole week, so I hardly realized I was jittering.  I had to use the inhaler recently again (it flared up again), and then the jittering came back and I realized what it had been.  

 

Hopefully she'll be on the mend soon!  :)

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Is she on the inhaler permanently or just till a sickness clears?  I had an inhaler for my pneumonia/bronch bout, and it made me jittery, yes.  But the effect was so good (opening my breathing, wow) that you might just give her something to calm the jitters and get her through it.  Did he give her anything to help her sleep?  I was on a codeine cough syrup that whole week, so I hardly realized I was jittering.  I had to use the inhaler recently again (it flared up again), and then the jittering came back and I realized what it had been.  

 

Hopefully she'll be on the mend soon!   :)

 

I'm hoping it's only temporary! 

 

I asked the pharmacist if there was anything I could do to counteract the effect but she said no. And the doctor didn't give her anything to help her sleep, but thankfully she's sleeping much better.

 

She was a little grouchy with me through the day yesterday. Before bed the distinctive cough started and I wasn't sure what to do because she obviously needed the inhaler but I was so afraid of another massive fit. She took one puff, as the doctor agreed would be okay, and went to sleep. Right before dozing off she said to me that she was sorry for how she acted. It was sweet that before the day was over she wanted to get that apology out, even though I realize it wasn't her fault.

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I'm glad the reduced dose was adequate!  That's a good solution if it works.  And you know sometimes it's about talking through and anticipating the symptoms and talking about what techniques you'll use.  (If the med makes you feel this way, here's what we'll do.  We'll hold the dog and pet him and listen to peaceful music and let it pass.)  Sometimes anticipating it and having a plan can help.

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I don't think she really needs two puffs. She's nine and that's the same amount my five foot nine inch solidly built oldest uses.

 

 

As an asthma mom, I have to comment on this.  Dosing for inhaled medication works differently from dosing for medication that is swallowed.  When you press the button on the inhaler, or run the nebulizer, it changes the proportion of medication in the air that's in the aerochamber or coming out of the mask.   How much of the medication actually makes into your lungs depends on how big your lungs are, and what size breath you take. Tiny babies need the same %age as bigger people, so they take the same number of puffs, at the same strength, but they end up with a lower dose because they have less lung surface.  

 

My 195 lb offensive linesman takes approximately the same "dose" of inhaled medication that he took as a 7 lb 6 week old (I say approximately, because he's moved from an nebulizer to an inhaler, and takes medications now that weren't on the market when he was tiny).   I'm glad the lower dose worked, but just wanted to be clear in case other people read this, that dosing for inhalers is not based on the size of the individual.

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As an asthma mom, I have to comment on this. Dosing for inhaled medication works differently from dosing for medication that is swallowed. When you press the button on the inhaler, or run the nebulizer, it changes the proportion of medication in the air that's in the aerochamber or coming out of the mask. How much of the medication actually makes into your lungs depends on how big your lungs are, and what size breath you take. Tiny babies need the same %age as bigger people, so they take the same number of puffs, at the same strength, but they end up with a lower dose because they have less lung surface.

 

My 195 lb offensive linesman takes approximately the same "dose" of inhaled medication that he took as a 7 lb 6 week old (I say approximately, because he's moved from an nebulizer to an inhaler, and takes medications now that weren't on the market when he was tiny). I'm glad the lower dose worked, but just wanted to be clear in case other people read this, that dosing for inhalers is not based on the size of the individual.

I second that!

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Didn't read all of posts, but I'd ask about reducing the dosage. I'm a petite adult, and two puffs of my albuterol is usually too much. One puff is usually sufficient to help the asthma symptoms without making me jittery or shaky. On the rare occasions I've needed two puffs for the wheezing, I have indeed felt jittery, shaky, and icky, and in a 9yo, I would definitely think it would cause behavior issues. Steroid inhalers don't have a noticeable mood effect on me, but I know that the time DD was on Prednisone for a few days (following a semi-severe allergic reaction to a bee sting -- completely reasonable course of treatment), she was definitely more irritable than usual. So I'm betting that your DD is reacting to the meds, but hopefully reducing the dosage will help a bit. Poor baby!

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As an asthma mom, I have to comment on this.  Dosing for inhaled medication works differently from dosing for medication that is swallowed.  When you press the button on the inhaler, or run the nebulizer, it changes the proportion of medication in the air that's in the aerochamber or coming out of the mask.   How much of the medication actually makes into your lungs depends on how big your lungs are, and what size breath you take. Tiny babies need the same %age as bigger people, so they take the same number of puffs, at the same strength, but they end up with a lower dose because they have less lung surface.  

 

My 195 lb offensive linesman takes approximately the same "dose" of inhaled medication that he took as a 7 lb 6 week old (I say approximately, because he's moved from an nebulizer to an inhaler, and takes medications now that weren't on the market when he was tiny).   I'm glad the lower dose worked, but just wanted to be clear in case other people read this, that dosing for inhalers is not based on the size of the individual.

 

This is great information. As someone clueless about asthma, I really appreciate it!

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I'm glad the reduced dose was adequate!  That's a good solution if it works.  And you know sometimes it's about talking through and anticipating the symptoms and talking about what techniques you'll use.  (If the med makes you feel this way, here's what we'll do.  We'll hold the dog and pet him and listen to peaceful music and let it pass.)  Sometimes anticipating it and having a plan can help.

 

 

I came home from being out all day and dd is having that little cough again. I hate hesitating about suggesting the inhaler because I'm afraid of her mood. 

 

Here we go with one puff...

 

I will definitely work on a plan with her. That's a great suggestion.

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My grandmother fell and was taken to the ER last night, so I had to head over there. Dd called me before she went to bed to tell me she took three puffs because something didn't work right the first time and she forgot to hold her breath for ten seconds for the first two puffs. I was so worried she would have an episode again but dh said she only seemed hyper.

 

My mom said dd seemed anxious when she took her out earlier in the day, and I remembered that dd used the inhaler before going out.

 

So she's functional with it now, though it still seems to be affecting her. Maybe it felt worse to her during the week when there were no activities and other people to distract her.

 

 

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This is what I noticed over the weekend.

 

Since Friday's meltdown dd used her inhaler without the spacer. I held off on the inhaler at first but it became obvious she really needed it. We started with one puff, but then it seemed it wasn't enough. So we went up to two. Still not great. 

 

On Sunday, we used it with the spacer, two puffs. We went out right away Sunday morning after using it. She did not meltdown in public but complained about feeling woozy and tired, but clarified that she did not feel sick. She still had a little bit of a funny cough but it seemed better than without the spacer, so the spacer did make a difference in symptoms but also made her feel funny.

 

I stopped by the hospital to check on my grandmother. I had mixed feelings about taking dd but she wanted to go. While we were there I took dd's pulse ox, with permission. It was 95-96% and her heart rate sitting down was 110. We went home after that and my mom stopped by to take dd to look at a camp a few minutes from home. She seemed to get upset but it wasn't clear why and shut down and wouldn't even talk to her grandmother, who always makes her happy. After getting home, I worried it could be blood sugar and tried to feed her but she wouldn't open her mouth. Even my mom, who is a children's therapist couldn't figure out if it was intentional or not. I squeezed juice from a juice box into her mouth. Very slowly she started to look more normal and ate something. 

 

In the evening she used the inhaler with spacer and her mood got very bad again. She wouldn't take a shower or take her antibiotic and since both were necessary I had to insist and she got more upset. She screamed and cried for about an hour in bed before falling asleep, sometimes letting me hug her, sometimes not. 

 

I just feel like everything is off with her right now. She wouldn't eat last night and I'm afraid she's going to have another blood sugar problem this morning and that makes the inhaler issue more complicated, basically more likely to end in a meltdown.

 

The doctor we saw last week asked me to call and let her know how she's doing today because she wanted to see if dd needed a stronger antibiotic. But I don't think that's the problem. I think I would feel better to have her looked at and her lungs listened to and see if there's wheezing, and change the inhaler. 

 

After my mom suggested it, I'm starting to think also that dd is having a PTSD reaction to a scary fall she had in January and if that's making her more emotionally fragile right now so that she's having a harder time dealing with the physical stuff. It might just all be explained by the illness but I just wonder. She didn't seem traumatized at the time and they did not think she had a concussion at the ER, but nothing seems right with her now. 

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Wheezing is only a symptom, but not a necessary one. Some people just don't wheeze. Some get so tight that there's not enough air for a wheeze to happen.

 

The not perfect oxygen and increased heart rate would be more than enough symptoms for either of my kids to need an immediate dose of meds. We can dose 3 times back to back before heading to the ER/dr.

 

She may need a round of oral steroids or more frequent albuterol, or both, to kick this episode.

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And my son's behavior on its own was a symptom that his asthma wasn't controlled.

 

I really feel like she had a sudden behavior change over night. She cries and acts out after the inhaler, but the other times aren't very good either. It's scary and I'm feeling so worn down. She's up now but she won't eat or take the antibiotic. I even suggested I go to the pharmacy to get the other antibiotic and pick up something she likes on the way, but she's not budging. I called the pediatrician and the allergy/asthma office and am waiting for calls back. I had to tell my coop that I'm not sure if I'll be in to teach today so be prepared to go on without me. Meanwhile, my grandmother is in the hospital and restrained because neither my mom nor I can be there and make sure she doesn't get out of bed and fall or pull out her tubes. My grandfather has bad hearing even with his hearing aid and really needs our support at the hospital, too, to communicate with doctors, etc. :(

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Albuterol throws off my blood sugar and makes me feel like I am having a panic attack.

 

Try feeding her like a hypoglycemic--6 mini-meals a day. See if dr will add something like pulmicort or flovent to help keep lung inflammation down as much as possible (you did mention an asthma dx earlier, right?)

 

Have you told her you think her medicine is making her feel bad? 2/5 my kids react to albuterol with similar out-of-control behavior; letting them know things were like this now but that they wouldn't always have to take albuterol so often helped.

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I just had one thought about the spacer. I believe the spacer's job is to make it so more of the medicine get into the lungs. So I'm wondering, if she uses the spacer she might only need 1 puff. If she uses the spacer and 2 puffs she could be getting more medicine and that's what is making her mood worse again?

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I have a good update. The pediatrician wasn't super helpful on the phone, but the allergist's office was great and brought dd in this afternoon. He did breathing tests with her and found her lungs to be clear and in much better state than last year!!! He said what the ped referred to as an asthma cough is actually from post-nasal drip!  Dd could even describe for him how her cough moved up from her chest to the base of her throat. So basically for the last couple of days at least dd has not needed the inhaler at all. He recommended a different antihistimine, one that would address her skin issues better, which is generally her biggest problem, and would also dry her up her mucus a little more to help the cough. We have a nasal spray script if she still needs that after trying the new antihistimine for a few days. I am so relieved! Bye-bye inhaler! 

 

FYI, he also said the albuterol can cause anxiety so it can really wreak havoc for kids who are already anxious.

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After what you describe, I am concerned about your pediatrician.  He seems rather flippant and not very concerned about some very concerning issues.  That he didn't know that albuterol could cause some serious behavior problems tells me that he really isn't that aware of side effects.  Heck, he could have simply read the package insert and figured that out or looked it up quickly.  Do you have other options for a pediatrician... one that would coordinate care with the allergist? 

 

ETA:  glad things are getting better.

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