Asthma Part II . . . Help, Please

[Purple Cat]

My DD6 had, or is having, an asthma flare. She had 3 days of oral steroids, and complained continuously that neither her albuterol or oral steroids was helping. I ended up taking her to the ER in the wee hours of the night because her ribs were retracting as she was breathing. We were prescribed a new series of oral steroids (5 days). We saw her allergist afterwards, and he changed her from albuterol to Xopenex. I informed both the ER dr. and allergist about her making slides (with lab tools) of parasite-infected water at a museum's workshop and becoming ill that night/the next day. Though that illness seems to have triggered the flare, neither seemed concerned about the possibility of an on-going issue from it because her fever and illness abated after 1 day.

 

Now, we are nine days out from the start of the second oral steroid series, now taking Xopenex, and she is still having labored breathing. Last night, I had to give her double the dose of Xopenex, something her allergist said I should do. We're definitely needing Xopenex every four hours.

 

Her asthma has been well-managed, save a bumpy month when she was first diagnosed. I remember hearing that if the flare doesn't end after 5 days something else is going on, like an infection, that needs treated.

 

BTW, I've seen no symptoms of seasonal allergies, and the allergist said her "great" peak flow meter readings likely resulted from her learning how to sort of spit when she blows to get artificially high readings. (In short, he said ignore the PFM and trust what I was seeing if they seemed contradictory).

 

Thoughts? Would you call her allergist again and say we're still having the same issue with little to no improvement? Would you take her to the general pediatrician?

 

Thank you in advance.

[KnitWit]

I have two asthmatics. We have never seen an allergist, just the Ped.

 

Do you have a nebulizer? Or is your dd using an inhaler? Does she have a *spacer* tube for her inhaler? If she cannot take a deep breath, she is likely NOT getting the meds in from an inhaler without a spacer. With what you have said, I'm hoping you have a nebulizer. That would allow her to get the most out of the meds.

 

We were changed to Xopenex and then went back to Albuterol. The Xopenex didn't seem to work well for us...but you said Albuterol didn't either.

 

The labored breathing would concern me with mine. You are her advocate. You know her. You may have to get *pushy*...not in a rude way...but the doctors only know what they *see* or are *told* without running tests. Follow your mom instinct. If you see/feel that your dd is distressed then take her in. At the very least, they can check her oxygen levels. Our Ped. told us that by the time you hear the wheeze or see the retractions, it is not *just beginning to get bad* but already *down the road* and needs to be managed. Of course, I took that advice and rushed a panicked kid to the ER one night where they let us SIT in the waiting room until the crisis had passed and she passed out asleep from sheer exhaustion from trying to breathe! I was CRAZY! I wish I had been pushy that night and not cared about being NICE.

 

I'm sorry I can't answer on the dr question. I've only used a Ped...but I would take her SOMEWHERE if she was mine. Maybe since what the allergist said isn't working you could consult with the Ped...just to get another look. She should not continue to be distressed for so long in my opinion...as a mom.

[Purple Cat]

Thank you for the response. She generally takes her albuterol (as well as her Pulmicort) via nebulizer. I only have the puffer and spacer for her Xopenex right now.

 

I like her asthma/allergist specialist. He's very kind, gracious, and knowledgable. But a second look by her pediatrician might be a good idea. My concern is something else is going on. Her pediatrician is very seasoned.

 

Thank you.

[sbgrace]

I would be concerned.

 

Is this allergist also a pulmonologist? Is there a children's hospital within a drive where you could see pulmonology?

 

I cross posted--the allergist is pulmonology too, then? I'd still want to take mine to a children's hospital if you have one with a good reputation.

[KnitWit]

Okay, if she has a spacer and she's not improving...yeah. I'd be concerned.

 

:grouphug::grouphug::grouphug:

 

I really hate asthma sometimes.

[Purple Cat]

Thank you. Her allergist has a dual specialty in pediatric allergy/asthma, but is NOT a pulmonologist. I like him because he himself has asthma and his daughter has my daughter's same anaphylactic allergies, so he GETS "it" in a profound way.

[Mrs Mungo]

Thank you. Her allergist has a dual specialty in pediatric allergy/asthma, but is NOT a pulmonologist. I like him because he himself has asthma and his daughter has my daughter's same anaphylactic allergies, so he GETS "it" in a profound way.

 

Have they done a chest x-ray? A sinus x-ray? A CT scan of her chest? Honestly, I would ask to see a pulmonologist. This sounds like more than a simple asthma issue. My son has COPD that is finally well controlled by Advair.

[momtotkbb]

Is there a chance that the oral steroid is a generic? I ask bec my ds had an asthma flare - they put him on oral steroids which was our general course of action - but he didn't improve and actually ended up getting worse. I hadn't realized that the oral steroids he was given were generics - there was an inactive ingredient in the generic that he's allergic to. We had to get the name brand steroid and he began improving in 24 hours.

 

Only one time have we needed an antibiotic w/ the usual course of meds - but he had contracted a virus from a friend that turned into a respiratory infection.

[Tap]

Yes, I would take her back to the allergist.

 

Xopenex is a great med, but not as fast acting as regular albuterol. One of the benefits of Xopenex is that it is less likely to cause the jitters/anxiety/racing heart types of symptoms.

 

From your posts it sounds like she is usually using a nebulilzer, but is just using the spacer for now....is there a reason why? Nebulizers are much more effective.

 

Just because you don't see typical seasonal allergy symptoms, doesn't mean she doesn't have them. Have you tried an antihistamine or Singulair (I know the dangers-just asking)? What does the allergist think about allergies as a trigger?

 

How often does she usually use the Xopenex? It should be a crisis med and not used to control the asthma. In theory, she should be using a steroid inhaler or other meds to control the issue and only needing the crisis inhaler occasionally. I understand she is having a flare now, but I am talking about on a regular basis, out side of the flare.

 

Are the parasites ones to be concerned about in the lungs? Many water borne issues can't be passed to humans in a casual manner, do you know if this one can? Maybe try the CDC website for information.

 

If the oral steroids and Xopenex are not controlling the issue in this many days, I would wonder if there is something else going on too. I would absolutely return to the doctor and insist that something change in her treatment.

Edited June 5, 2012 by Tap, tap, tap

[almondbutterandjelly]

Yes, get in to see the allergist again. More needs to be done.