Dr. Hive: Asthma

[Quad Shot Academy]

My 4yo son never had a sign of asthma until 2 months ago when he had a full blown asthma attack where his pulse ox was 90 for an entire week. I posted about it here. He was on oral steroids and an inhaler every 3 hours for a week.

 

Then he was fine for weeks, until one day he came running to me saying he needed his inhaler. He had been quietly playing in his room. He was gasping for air. I had him lay down to watch his breathing and called our doc to try and get him in because I wanted a diagnosis if it was asthma again. She had closed early for the day and his breathing recovered within 20 minutes. Then he was fine for weeks again.

 

The past two weeks he has been fighting a "cold". It finally occurred to me that no-one else is sick and he keeps getting sicker/better a lot. He tends to wake in the morning with chest congestion, coughing and dark under eye circles. This morning our oldest woke us saying that his brother couldn't stop coughing. I gave him honey and put him on the couch. He was non stop hacking for 5 minutes. I finally woke up enough to think to try the inhaler. He stopped coughing immediately afterward, fell asleep in seconds and has not coughed once since. Does that mean it is asthma? Would the inhaler have worked if it wasn't? Is it within normal to develop sudden asthma at age 4? The only unusual thing that happened before it developed (a whole 6 weeks before) was that he had a severe allergic reaction to an antibiotic.

 

What is the next step? His bedroom seems to trigger it, but all the linens are washed frequently. There are allergen covers on the pillows and mattresses. The are no/few stuffed animals in the room. The only thing I can think besides a thorough cleaning of the room is that the mattress on the bunk right above him only has an allergen cover on the top, so the bottom (right above his head) is exposed. What will the doctor do? Order tests? Have me use the inhaler as needed? Want him on an oral med? I am clueless about asthma. Please help!

[Pippen]

The inhaler probably wouldn't have worked if it wasn't asthma. If you'd have been using a nebulizer instead the mist might have helped.

 

The next step usually is inhaled steroids along with the albuterol he's probably already using on a regular basis until the inflammation is down. If he's really flared up, a week isn't a lot of time to settle it down.

 

Either way, I'd call the doctor right away and if you can't get him in, use the inhaler every three hours as a preventative measure.

[Tess in the Burbs]

My dd was diagnosed with asthma last year and I thought they were nuts. The only time she had issues was winter. She would get sick and have this 'nighttime' cough for weeks. That was the first sign. She did get albuterol that winter but so did my ds, so I didn't think much of it other than it's an illness thing. But the cough took forever to go away.

 

She passed her breathing tests but they said if the cough returns or she needs another breathing treatment it's asthma. I still didn't believe it.

 

We all got sick that winter but sure enough my dd coughed and coughed. The inhaler helped. My Dr gave me an inhaler. It too, worked.

 

We do allergen control. Come winter the humidifier comes out. The inhaler is in the house. She's only had 2 incidents with low pulse ox. But they still say it's asthma.

 

My ds has a new Dr and he recommended my ds also get an inhaler. At this point we will most likely buy a nebulizer too. I realize you son may not seem sick most of the year. For us this is a winter issue. But even myself needs an inhaler every winter now, so perhaps the problem is there but you didn't recognize the symptoms? I never knew a nighttime cough is a sign. My own mom needs to get checked, lol.

 

I don't mind the diagnosis now. I didn't want it at first for her. But I do like having the inhaler in the house when it's needed. And I can get the albuterol when we need it without hassle. It's better to be prepared. And like you, it didn't seem like asthma, but it is. :grouphug:

[Pippen]

I also thought to mention, the sooner you get this checked out, the better. It goes against everyone's grain to medicate instead of take the wait and see approach, but with asthma, medicating early and often usually results in using far less medication than waiting does.

[Quad Shot Academy]

I also thought to mention, the sooner you get this checked out, the better. It goes against everyone's grain to medicate instead of take the wait and see approach, but with asthma, medicating early and often usually results in using far less medication than waiting does.

 

Thanks Pippen. I am on complete bed rest until my baby comes (any day now, but it could be two weeks.) I will call the doc today to see if it is worth bringing him in anyway or see if hubby can. I only have a few pumps on the inhaler anyway, so that needs to be refilled.

[dtsmamtj]

You might want to check for mold in corners of the room or around the window frames/glass. I too have "seasonal" so to speek asthma - where it comes and goes.

 

T

[Michelle in AL]

You probably need a nebulizer. It's more effective than the inhaler, is easy to use and your doctor may even have them to give out at the office. An office visit sounds like it's in order.

[Paintedlady]

My son developed asthma at age 4. In his case it came with hives as well as breathing problems. At first he was diagnosed with exercise-induced asthma but it progressed and he started to have episodes even when not running/playing.

 

We took him to an allergy specialist and he prescribed ds 5mg of Zyrtec (which is now over the counter) and that worked for several years. When he was about 7 he began to have break-through episodes even though he was taking medication daily. The Dr. upped his dose to 10 mg of Zyrtec and added 5 mg of Cingulair. He'll be 10 next month and hasn't had a break-through episode at all, unless he forgets to take his medicine.

 

I really believe in management through medication rather than reacting to an episode after the fact. It's much harder to get a handle on it after the episode has begun. I hate daily medication but it's made a huge difference for ds. I wouldn't hesitate to look into daily medications if he's having this many episodes. Asthma is scary! :grouphug:

Edited December 23, 2010 by Paintedlady

[Dana]

I also thought to mention, the sooner you get this checked out, the better. It goes against everyone's grain to medicate instead of take the wait and see approach, but with asthma, medicating early and often usually results in using far less medication than waiting does.

 

The medication to treat asthma also (in my understanding) helps prevent further/later lung damage (which can happen if the asthma symptoms are left untreated).

 

My husband has pretty severe asthma (I remember him being hospitalized for asthma attacks when we were first dating). Our son doesn't have "classic" asthma symptoms, but he does have allergies. This spring/summer his allergist diagnosed him with "silent" asthma. He doesn't have the traditional wheeze, but he did have a cough at night that wouldn't stop without a breathing treatment (xopanex in nebulizer - he has bad reactions to albuterol).

 

So, yes, you can be diagnosed with asthma at any time (ds was 7) and cold symptoms can be signs. The circles under your son's eyes are called "allergic shiners" and can be a sign that there's an allergen he's responding to.

 

My son's on Flovent (inhaled steroid) - 1 puff twice a day. That's what he needs to manage his asthma. Don't avoid steroids if they're prescribed. Stay on the low maintenance doses rather than allowing things to progress to needing serious prescribed doses to cope with asthma flare ups. I'm still ticked at choices dh's parents made that did him long-term harm.

[Murmer]

My dd was diagnosed at 2 and when we removed her allergen we thought that would take care of it...FFWD to 1 year later we are in the hospital and she is in breathing distress...she is now on a daily steriod inhaler and albuterol when needed...she is doing really well and we have had very little problems...DS has had breathing issues since birth, diagnosed with reactive airways at 4 months and we have only used a rescue inhaler until this year when he also had distress and I made the doctor see him with the distress...he is now officially diagnosed and also on the daily steriod for the winter. I would keep on your doctor until you have a daily answer. The rescue inhaler is just that a rescue inhaler for the times when its needed...I was told if we are using it more than 2 puffs every 4 hours we needed to be in contact with our Dr or the ER. If your doctor won't then go to a respritory specialist. FYI my children never had low O2 issues just distress, wheezing and grunting.

[sbgrace]

Yes, I'd be thinking asthma as others said given the cough and response to the inhaler.

 

It is much better to treat ahead of flares--you can avoid those oral steroids often which are hard on the body.

 

It sounds like allergy related and so something like Zyrtec might help enough. My son needs Singulair as well. Singulair is very good with viral/cold induced asthma but it has been shown to help allergy induced as well. My son does well with it and we don't need inhaled steroids

 

On the why now...the allergic reaction to the antibiotic may be a piece of that puzzle along with (possibly) something seasonal. I don't know what triggers in winter seasonally but my son has had issues this winter season. Anyway, there is a bucket theory for allergies/asthma in that when the body is "full" it starts spilling with new reactions. So in my mind that antibiotic could have been the last drop sort of thing. There is actually a hospital (Boston? I can't remember) where they use bucket theory to actually eliminate some allergies. Part of their protocol is to control asthma and etc. My point is this is likely all related.

[ahousefullofjs]

I have one with Asthma here, diagnosed at age 2. I agree with others about the nebulizer. Regarding the bunk beds, our asthma guy was on the bottom bunk, and was absolutely miserable even though both top and bottom mattresses were completely encased, as were the pillows, all linens were washed frequently and dried on HOT. It's also important to do a regular vacuuming anywhere dust can settle. We were also advised to regularly dry any stuffed animals on hot for a minimum 30mins to kill mites there too. We did all of this but it wasn't until we moved him to the top bunk that his nighttime allergy/asthma attacks stopped. We heven't had a single nighttime episode since making that change.

[TheCoffeeChick]

His bedroom is not neccessarily "the" trigger. Asthma symptoms are worse at night for many people. For me, when my asthma is acting up, I will wake up between 3 and 4 coughing and unable to breathe.

 

Also, please don't make your ds lay down to try and breathe better - that makes it harder. Sitting up or standing is much better.

 

I also agree with the other posters who said that preventative treatment is much better than waiting for an attack to treat. Using a peak flow meter 3 times a day and charting the numbers are a much more effective method to see if his breathing is getting worse. Also a daily low-dose inhaled steriod is very effective in eliminating attacks.

 

:grouphug:

[Mrs Mungo]

My son has a lung disorder that is not asthma.

 

My son is on an advair inhaler and takes a low-dose zithromax. In some climates he has needed a nose spray like nasonex.

 

He was on Singulair for a while; that med takes a while to build up in your system. It is well known to cause mood disorders, especially in kids. We had to take my son off it after a year because he was eventually just horrible.

 

My son gets "allergic shiners," and reacts to certain thing as if he had allergies. However, allergy testing has been fruitless, both skin tests and RASTs have been negative.

 

You need to be referred to a pediatric pulmnonologist for a full evaluation. In my experience, general practitioners do not have enough experience with this type of thing to diagnose and treat it.

[celticmom]

When you described his room, you did not mention the type of flooring and/or rugs. If there is carpeting that can be a major allergen trap I have asthma and cannot live in a carpeted house. I would also be very careful about thoroughly cleaning any floor rugs or eliminate them from his room altogether.

[AnitaMcC]

Definitely have your son checked out by the doctor!!!!

 

It is very important to be proactive with asthma. Don't just react to the flare ups. Often there are underlying asthma going on without patient even being aware of.

 

I have severe chronic cough variant asthma (I have symptoms daily). Mine is difficult to treat as many meds I can not take (I am severely sensitive to albuterol, etc). I take prednisone often.

 

All four of our kids have asthma. Ds#1 and Dd were dx when 8 months old, Ds#1 was hospitalized 5 days at 10 months old for RSV and asthma complications. Ds#2 was dx when he was 2yrs old, Ds#3 was born wheezing (literally).

 

Doctors thought it was "interesting" that all four of our kids have asthma so young... and it is statistically supposed to be only 25% chance of our kids having asthma.

 

Ds#1 take singulair, zyrtec, and steroid inhaler every day. He also has xopenex inhaler/nebulizer as needed.

 

Dd, Ds#2, Ds#3 uses xopenex inhaler/nebulizer as needed. Colds are mainly when they get symptoms and can go on for weeks and have to take nebulizer for several days. We also keep prednisone on hand. Dd has exercise induced asthma also so she takes her inhaler before cardio/competition training and sparring classes. The younger two are watched for symptoms of colds, etc as that is pretty much the ony times they have asthma symptoms.

 

Winters are hard on us due to virus's keep going around.

[Quad Shot Academy]

Thanks for all the replies. I just talked to the doc and she says it is definitely asthma since the inhaler worked. Hubby is taking him in at 4 and will come home with an "asthma action plan". I am worried what this will be. :001_unsure: I will check with all of you to see if you agree with her. ;)

[Dana]

Thanks for all the replies. I just talked to the doc and she says it is definitely asthma since the inhaler worked. Hubby is taking him in at 4 and will come home with an "asthma action plan". I am worried what this will be. :001_unsure: I will check with all of you to see if you agree with her. ;)

 

Don't worry. :grouphug:

 

An asthma action plan is just stuff that you've already heard in this thread - general steroids for maintenance (something like Flovent or something similar). You'll hear about any side effects to watch for so if a medication needs adjusting you can (like my son's reaction to Albuterol - he also has a Singulair reaction (nightmares & stomach aches)). You'll hear about signs to watch for and indications on when to go in to the doctor or ER.

 

It may be scary initially - he'll probably be home with quite a few prescriptions. It'll be an adjustment, but it'll be okay. Just do remember to keep the maintenance inhalers/steroids going - even when you're not seeing symptoms. This is long term maintenance. (By doing Flovent, we haven't needed Xopanex in months.)

[Quad Shot Academy]

Don't worry. :grouphug:

 

An asthma action plan is just stuff that you've already heard in this thread - general steroids for maintenance (something like Flovent or something similar). You'll hear about any side effects to watch for so if a medication needs adjusting you can (like my son's reaction to Albuterol - he also has a Singulair reaction (nightmares & stomach aches)). You'll hear about signs to watch for and indications on when to go in to the doctor or ER.

 

It may be scary initially - he'll probably be home with quite a few prescriptions. It'll be an adjustment, but it'll be okay. Just do remember to keep the maintenance inhalers/steroids going - even when you're not seeing symptoms. This is long term maintenance. (By doing Flovent, we haven't needed Xopanex in months.)

 

Ugh. My hubby can't take him, so my best friend is. I hate that I will be missing all this information and have to rely on second hand info. I am so tempted to just take him myself, but with my luck, I would have the baby in her office. :tongue_smilie:

[Ellie]

My dd was diagnosed with asthma, but now I'm thinking it was reactive airway disease. It seems to be treated pretty much the same way, but it has different triggers than asthma (my dd only had an attack when she had an upper-respiratory infecton).

[Quad Shot Academy]

She said he was wheezing and his O2 was 97. She gave him his rescue inhaler and he sounded a lot better. She put him on Flovent, 2 pumps, twice a day and the rescue inhaler as needed.

 

I can't believe how expensive Flovent is! :001_huh:

 

That is all that she recommended at this point. I did manage to get him in to his allergist next week and will ask that he do the basic scratch testing. (He has seen the allergist for his allergies to antibiotics, but has never been tested for foods or environmental things.)

 

When I get off bed rest we will deep clean his room. The Lego table has gotten a bit dusty. :) He will also be taking Zyrtec for the next week for an eczema flare up.

 

Does that sound right? Do any kids wear medic alert bracelets for asthma? He has one for his allergies to antibiotics and it would be easy to add.

[Dana]

Sounds about right.

Do you have a spacer for the inhaler? If you don't, it'd be a good thing to get. Flovent is available as a traditional inhaler, but I think it's also in Discus form (unfortunately, it uses milk as an ingredient, so we can't use it).

 

In time, if things are controlled, you may be able to drop amounts. We do just one puff of Flovent a.m. and p.m.

 

We did the scratch testing this summer, but you may want to ask some questions before having it done. We now know ds is allergic to just about everything, but we haven't made changes as a result of the skin testing. If you were considering shots as a result, get the testing done, but do figure out what info you'll get and what you'll do with that info.

 

Ds is on Zyrtec daily and has been for years. It's nicer that it's OTC now. You can build up a tolerance to it, but it does help with allergy symptoms.

 

I doubt I'd add asthma info to a medic alert bracelet. Unfortunately, I hear that they aren't checked as often as they should be. I still have ds wear his, but I don't count on it for safety :(

[LizzyBee]

The medication to treat asthma also (in my understanding) helps prevent further/later lung damage (which can happen if the asthma symptoms are left untreated).

 

This. There can be inflammation even after the wheezing stops, and the inflammation is what causes permanent damage. It's important to use meds until the inflammation is clear, and for that reason, you need a dr appt when an asthma attack starts and follow up appts every couple of days until you get the all-clear from the dr. You need a pediatrician who knows how to treat asthma and takes it seriously - some of them are really clueless. One of my sisters died from asthma 5 years ago, and now another sister has life-threatening asthma and allergies. So I am pretty aggressive about treating my dd's asthma!

[LizzyBee]

He was on Singulair for a while; that med takes a while to build up in your system. It is well known to cause mood disorders, especially in kids. We had to take my son off it after a year because he was eventually just horrible.

 

 

My dd was on Singulair for several years and it worked great for keeping her asthma under control. Unfortunately, she also went through a pretty severe depression, and we didn't know at the time that Singulair could have been the trigger. She now has a note in her patient file that she is not to be given any medications known to cause mood disorders unless absolutely necessary.

[Dana]

One of my sisters died from asthma 5 years ago, and now another sister has life-threatening asthma and allergies. So I am pretty aggressive about treating my dd's asthma!

 

:grouphug: I'm sorry.

 

When my husband was hospitalized for his asthma, he had a couple of doctors lecture him saying that people die from asthma. He still didn't take it as seriously as he should for a couple more years.

[Pippen]

Flovent is an inhaled steroid and can take a week to be fully effective, so if it it were me I'd feel free to use the rescue inhaler more frequently until it seems to be working. Flovent also needs to be used regularly to work so you don't want to miss doses while he's flared up.

 

I let my asthma go to far because I didn't want to medicate while I was nursing. It took three years before my lungs were back to baseline.

[Quad Shot Academy]

Flovent is an inhaled steroid and can take a week to be fully effective, so if it it were me I'd feel free to use the rescue inhaler more frequently until it seems to be working. Flovent also needs to be used regularly to work so you don't want to miss doses while he's flared up.

 

I let my asthma go to far because I didn't want to medicate while I was nursing. It took three years before my lungs were back to baseline.

 

Yes, we are still using the rescue inhaler since his O2 is down and he is still coughing. He did sleep through the night for the first time in 2 weeks, so that was nice.

[Quad Shot Academy]

His bedroom is not neccessarily "the" trigger. Asthma symptoms are worse at night for many people. For me, when my asthma is acting up, I will wake up between 3 and 4 coughing and unable to breathe.

 

Also, please don't make your ds lay down to try and breathe better - that makes it harder. Sitting up or standing is much better.

 

I also agree with the other posters who said that preventative treatment is much better than waiting for an attack to treat. Using a peak flow meter 3 times a day and charting the numbers are a much more effective method to see if his breathing is getting worse. Also a daily low-dose inhaled steriod is very effective in eliminating attacks.

 

:grouphug:

 

Thanks for the tip on sitting up. How old do you have to be to use a peak flow meter?

[TheCoffeeChick]

Thanks for the tip on sitting up. How old do you have to be to use a peak flow meter?

 

Sorry I didn't get back to this -- I haven't been on a lot in the last few days. :tongue_smilie:

 

A peak flow meter can be used by anyone who knows how to blow hard on command. So, obviously a baby couldn't use one, but your 4yo may be able to. For someone so young, I'd do it 3 times in a row each time I was recording the results, just to make sure the reading is correct.

 

 

I have 2 of them on hand for some reason, one looks like the one on the left and the other one I have is like the one on the right. The readings are based upon your age, sex, and height in adults and on just height in children. I would think that ALL asthma plans would include a peak flow meter -- your doctor may think your ds isn't old enough to get a good reading. This website: http://www.peakflow.com/top_nav/normal_values/index.html has a pdf file with the normal values for both adults and kids.

 

:grouphug: Having asthma is not the end of the world, but it does make things difficult when it is not controlled. I hope you are able to find what works for your ds.

[Ottakee]

Thanks for the tip on sitting up. How old do you have to be to use a peak flow meter?

 

If he can't quite do a peak flow meter right now, google peak flow whistle. It is a little whistle that you can set to certain numbers--if they can make it whistle they are OK, if not, then they need help. Not as accurate as the exact peak flow number, but still helpful.

 

Honestly, I would get an appointment with a pediatric pulmonologist and get a treatment plan in place. This will tell you which meds to use when, when to call in, when to go to ER, etc.

 

My daughter was very ill when she was little---think 02 levels of 74% or less. Now that she is older she is doing much better. Her triggers are still allergies at times but mostly just colds.

 

The doctors have given me an arsenal of meds to use as needed. I know that if she starts coughing, start up ........., if that isn't enough then do .........., use the nebulizer if ..........., add the steroids when ..........

 

Now when we travel I just take everything along but rarely have to use it.

[Pretty in Pink]

Asthma is very scary. I am sorry that you are dealing with this. :grouphug:

 

I will second (third?) the recommendation of seeing a pediatric pulmonologist. IME, may general practitioners and pediatricians do not have the experience or knowledge base necessary to optimally treat an asthmatic child.

[Quad Shot Academy]

He is at the allergy/asthma doctor right now; I will let you all know what he says.

[Quad Shot Academy]

Hubby just called. He hasn't talked to the doctor yet, but he said they already gave him a peak flow meter. ;) The only thing he tested slightly positive for is cat and we don't know anyone with a cat, so that is not the cause. The nurse suggested that it was cold air, which it could be. We keep the house at 62, but I am always cold so I bump it up to 70 most of the time. Since I am huge and prego, I have only been bumping it up to 64 or 66. His room is the coldest in the house, so we will be using a space heater or running the furnace more to see if that helps. I will let you know if the doc says anything else interesting. Thanks for all the replies and help!

[Ottakee]

I wonder if the cold air thing is more of an outdoor air thing. Even at 62, kids play outside all of the time at 62 and it is not cold.

 

I know for us, the biggest trigger is illness--ear infection, bronchitis, pneumonia, a cold, etc.

 

Glad to hear though that he got into a specialist so quickly.

[Quad Shot Academy]

My son has been doing really well. His peak flow meter readings have gone from 70 to 100. I am not sure if it is due to a warmer house, the flow-vent or just learning how to use the meter. Last night I accidentally skipped the flow-vent and this morning he was hitting 50. A few minutes after his flow-vent he was hitting 60. Do you think one skipped dose could effect him that much, or do you think it was just a coincidence? I was told to start him on oral steroids and albuterol if he got that low, but his breathing seems fine.

[Ottakee]

My son has been doing really well. His peak flow meter readings have gone from 70 to 100. I am not sure if it is due to a warmer house, the flow-vent or just learning how to use the meter. Last night I accidentally skipped the flow-vent and this morning he was hitting 50. A few minutes after his flow-vent he was hitting 60. Do you think one skipped dose could effect him that much, or do you think it was just a coincidence? I was told to start him on oral steroids and albuterol if he got that low, but his breathing seems fine.

 

Have him repeat the peak flow about an hour later (sooner if any signs of trouble) and if it is still low, then at least start the albuterol and go from there. It could have just been a fluke, etc. It can take 1-2 months though of regular use for the Flovent and other preventative meds to really kick in full force.

 

My daughter was one that could crash quickly. I could put her down for a nap just fine and she might wake up a short time later in distress.

 

If you have any concerns, certainly call the doctor, esp. since you are new to this. Our pulmonologist said it is much better and easier to hit it HARD AND FAST than try to play catch up which in the long run might mean more meds, higher doses, etc.