Asthma (during Pneumonia and general) ?'s

[sbgrace]

My son was diagnosed with pneumonia and asthma yesterday.

 

The doctor prescribed an antibiotic, an inhaler, Claritin, and oral prednisone.

 

My husband took him so I wasn't there to question any of this but I'm sort of confused and unsure.

 

1. The pediatrician told my husband that asthma is asthma and so my son is an asthmatic and likely has environmental allergies. I have never, until this pneumonia, ever seen any signs of asthma in this child. His twin has asthma. I know what it looks like and I knew we were seeing some in this illness but that's the first time. I have never seen any allergies in this child either.

 

Is it true he's now asthmatic or can a respiratory illness be a temporary form of asthma?

 

2. I don't want to do the oral prednisone unless I have to! I've had to use it in my other child after anaphylaxis and once in a really bad spiral of asthma we couldn't pull out of otherwise. But his allergists and pulmonologist have never recommended it without clear need.

 

Now I have this child with a new onset of asthma during pneumonia and he comes home with oral prednisone. Is it reasonable to try every 4-6 hour albuterol and the antibiotic and see if it kicks the asthma down without prednisone?

 

Why would I start Claritin in a child who has never shown a single allergy sign? I wish I had gone with him to the doctor!

[Arcadia]

I had childhood asthma and than asthma again when I was in university. It is possible for both asthma and pneumonia but it need not be both. My granduncle had pneumonia but not asthma.

 

Call the doctor office and the nurse should be able to read to you the full prescription for your child, the dosage and whether it is a standby medicine or it has to be taken. You can also ask for a call back from the doctor.

 

My kids paediatrician would give me a prescription for standby medicine when my kids are sick if it cannot be bought over the counter.

[kagmypts]

I am coming from a different perspective because I have a son with asthma. He does not have "typical" asthma - wheezing, shortness of breath, etc. He has cough variant asthma, and it took us years to have him properly diagnosed. As I am sure that you can imagine, asthma can look very different in different children. While our pediatrician was trying to figure out what was causing his breathing issues, we had numerous trips to the E.R. for respiratory problems (his lungs were always clear). We had trips in ambulances from the pediatrician's office to the local children's hospital because his oxygen levels were not at appropriate levels. It was awful and nerve-wracking, and I never wish that experience on any other person.

 

However, oral steroids were and continue to be our savior. For my son, oral steroids have kept us out of the E.R. and have kept him from having severe breathing issues. While I don't like him being on steroids, it is far better than him not being on them. I don't know your son or his medical history, but I do know that asthma and pneumonia can turn very serious, very quickly. If you don't feel comfortable with the doctor's orders, I would call and seek clarification. In any event, I hope your son feels better soon!!!

 

ETA - My other son has recurrent wheezing, and it's not asthma.

Edited October 24, 2012 by kagmypts

[renmew]

My son was diagnosed with walking pneumonia two weeks ago after almost 7 weeks of a cough (no other symptoms). The doctor prescribed an antibiotic when she "heard something" in his lungs while breathing, and believed she "saw something" on his x-rays. It would have taken a few days to be read by the technician. We followed up almost a week later with another doctor. The x-ray had been read by then (negative) and my son was still coughing, despite finishing up the 5 days of antibiotics.

 

This doctor believed there never was any pneumonia, and diagnosed "reactive airway disease," or basically a step below full-blown asthma (her words). I have had full asthma my whole life, but my son had never shown any signs of it. She said he was wheezing some, so she gave him a nebulizer treatment there in the office and sent him home with an albuterol inhaler. We've used in about once a day since, and he is still coughing, although much much less. She did say that if I noticed him wheezing or coughing after exercise/sports, then that would convince her he had more of a full asthma thing going on.

 

Hope that helps!

[Denisemomof4]

My dh has seasonal allergies which mostly cleared up when he had sinus surgery. I don't know if all asthmatics also have allergies.

 

In the past decade or so, dh now is susceptible to sickness induced asthma. He ONLY gets it if he is diagnosed with bronchitis or pneumonia. He will take meds and be on inhalers until no longer needed, and I do believe steroids is a med usually given.

[Elizabeth in MN]

1. Respiratory illness can be mistaken as a form of asthma, both by doctors and patients. Phlegm can rattle around and sound like a wheeze. It's hard to tell if it's a phlegm wheeze or an asthma wheeze, even when you know the difference.

 

2. Use the Prednisone. It can be a life saver where pneumonia is concerned. It's the only way I recovered from two different times I came down with lung issues.

 

3. The allergy meds are a weird one. Maybe it's to help clear up the mucus? I don't really cotton to that mentality (mucus helps clean out a body IMO).

[Denisemomof4]

1. Respiratory illness can be mistaken as a form of asthma, both by doctors and patients. Phlegm can rattle around and sound like a wheeze. It's hard to tell if it's a phlegm wheeze or an asthma wheeze, even when you know the difference.

 

2. Use the Prednisone. It can be a life saver where pneumonia is concerned. It's the only way I recovered from two different times I came down with lung issues.

 

3. The allergy meds are a weird one. Maybe it's to help clear up the mucus? I don't really cotton to that mentality (mucus helps clean out a body IMO).

 

I missed that your ds was put on allergy meds. :confused:This doesn't make sense to me. Dh is usually given antibiotics, steroids and inhalers.

[J-rap]

Every person with asthma who I have known also has allergies. This includes 4 of my 5 children. For some, the allergy connection is very strong. For others, the allergy connection is mild, but then a cold will trigger it.

 

For all of them, it began suddenly with either a bad seasonal allergy or a cold, somewhere between the age of 5 and 10 or so.

 

Two of my daughters had their first asthma attack in the fall. It was clearly a seasonal connection, and they didn't have colds. For another daughter, she had a cold and that's what triggered it. However, she also had a very mild, underlying allergy. My son has bad spring allergies, and that's when he had his first asthma attack.

 

For all of them, their asthma isn't consistent at all. They might go years without having trouble, and then suddenly it kicks back in, almost overnight. My daughter who lives in Central American has no asthma or allergy problems at all down there. Within hours after returning home to the U.S., both her asthma and allergies kick in. Cats and mold can now set it off. Even running can set it off, but only here -- where she has allergies. If she runs in Central America, she is fine.

 

Another daughter (the one who mostly just got asthma with colds) didn't have asthma problems for about 10 years. This year she is living in an old building in England out in the country, running every day... Suddenly, her asthma has returned with a vengeance. No cold, just asthma. I don't know if it's the old building, the particular crops in that area, or what.

 

Don't know if those examples help or not! Maybe they will give you a little insight.

 

As far as prednisone: at the time of an actual asthma attack, the prednisone was important. Inflammation had been building up in their lungs, and by the time it showed as an asthma attack, the inhaler alone wasn't enough to keep it controlled. Only the prednisone could actually take down the inflammation. It really did the trick. They were only on it for 3-5 days I think, but I think it was necessary. They had dark circles under their eyes and felt miserable, but after just a couple days on prednisone, they looked and felt so much better!

[sbgrace]

Thank you all for your replies.

 

It is pneumonia for certain (stuff is in the lungs). I was hearing a deep/wet/nasty cough. But I would also sometimes hear a constant dry cough, usually in the morning, that I thought was cough variant asthma. However, it wasn't responding much if at all to his twin's inhaler so this leaves me uncertain still. Maybe it's because he needs the prednisone. I just don't want to do it if it isn't needed.

 

I saw that the most common bacteria that causes walking pneumonia also seems to cause onset of asthma (in mice and humans) so that's disappointing for me to read.

 

I guess I need to do the oral prednisone. I hate that. I also question it a little since I have Claritin too and that makes no sense at all that I can tell. It makes me wonder if this doctor is a asthma=inhaler, prednisone, claritin sort or something. We're new to the area so I've never seen this person before.

 

I already feel like a horrible parent. I waited this thing out since Oct 8! He started with really high fevers (103-104) and then they dropped (101-102) and I expected the cough to improve. Then just as I decided to take him in they dropped again (99-101) so I just kept thinking he was getting better! He never had breathing problems or pain and the on call phone doctor I talked to early on in the course of this led me to believe that indicated it wasn't pneumonia.

Edited October 24, 2012 by sbgrace

[TravelingChris]

We have three asthmatics here. I have adult onset asthma and mine is never triggered by allergies. I do have allergies- multiple drug allergies and some environmental ones- but those have never caused asthma. My asthma triggers are air pollution and illness. My dd with it had the diagnosis of Reactive Airway Disease for years and now I guess it is asthma but I am not really sure. She does have an inhaler. Her triggers are air pollution, illness, anaphalactic reaction, and probably some exercise but that is unclear whether it is the exercise or air pollution. My dh has exercise in cold weather as a trigger and really nothing else, except it would happen if he was in a smoky environment but that is not something he encounters anymore. The Air Force did not call it asthma but something else but he got an albuterol inhaler just as the two of us did.

 

Anyway, I always get put on steroids when I have pneumonia or bronchitis. I also get antibiotics but no one has ever put me on allergy meds at that time. I only get allergy meds if I have allergy problems.

[Suzanne115]

I have asthma and my daughter has Reactive Airway. I would go ahead and give your child the steroids. They have been a lifesaver for both me and my daughter. A short term dose shouldn't harm him. I know they make my daughter kind of loopy and once after a long dose they made me overly emotional so I understand your reluctance. The pneumonia and asthma will complicate each other so her probably needs the medication the get over it all.

 

 

I hope he feels better soon. If you have questions about the Claritin, I would give the doctor a call. He or she should be able to explain everything to you.

 

Blessings,

Suzanne

[Acorn]

I would call and talk to the doctor yourself just to clarify your questions. Last year, my son had pneu. He started an antibiotic and was already on a daily antihistamine. He was getting worse, so we went back in and he was diagnosed with asthma. I was told that it could be asthma related to the illness and not necessarily life long. They did caution though that if he got sick again we could see it again. He is set up with asthma medicine but we haven't used them in the past year.

[Matryoshka]

Two of my kids have Reactive Airway Disease (RAD) which is considered a form of asthma. However, they have only ever been symptomatic when they have a bad cold/cough (although not with every cold/cough - it's amazing how random it is).

 

One of my twins had a really bad episode when she was 8 and had pneumonia and was hospitalized for 8 days, 3 in the ICU. After that she was on low-dose pulmacort for a couple of years (the steroids can help recurrence), but now she's been off it for years, and just takes it for around 2 weeks if she is sick with wheezing.

 

However, neither of them have had a single episode of wheezing without there being an active infection of some kind.

 

I do think there might be some kind of seasonal component, as they seem to get this stuff in the fall (the pneumonia was in Sept) and sometimes spring, but rarely winter - but I had her tested for seasonal allergies and they all came back negative so I'm :confused:. Maybe something they don't test for?? But knock wood, it seems to get less and less often as they get older (like less than 1x/year).

[Suzanne115]

My daughters has gotten better as she has gotten older too. She only has asthma like symptoms during a cold or illness. Most of the doctors we have seen for her have diagnosed her as Reactive Airway, but one did think she had full blown asthma. She has been allergy tested twice and both times the test didn't reveal anything, but I know she has allergies. We just use Claritin or Zyrtec if it gets bad enough to bother her.

 

 

Suzanne

[butterflymommy]

Sometimes asthma is triggered by respiratory colds and pneumonia. I think this is called intrinsic asthma. Allergen induced asthma is extrinsic. My dr says to stop prednisone after 3 days if they're better, so go ahead and give it to him short term In all honesty I have stopped after one day if they are a lot better. I've also been given permission by the dr to use albuterol every 2 hrs on them if necessary but I wouldn't do that without a dr's consent. If he has ongoing inssues make sure he gets on a preventative like pulmicort.

[SMRB]

Both of my kids have asthma, both cough variant, with one triggered by allergies and the other triggered by viruses in winter. Neither child ever wheezes, and they always have clear lungs even during a flare.

 

If albuterol is not working, it either isn't asthma, or it's asthma at the point that you definitely need the steroids. If albuterol is working, but it is not lasting 4 hours before he needs it again, you need the steroids. You will definitely see improvement in under 24 hours if the steroids are working. We have managed many flares with aggressive albuterol, tapering it down over a week, and we have avoided steroids several times that way, but I wouldn't mess with pneumonia.

 

With pneumonia in the mix, I would do at least the first dose of steroids. If there's no improvement after 24 hours, I'd go back to the doctor. When the pneumonia is resolved, I'd suggest a pulmonologist and/or allergist to find out if there's really asthma involved, or at least a visit to the pediatrician to talk about whether a trial with a controller inhaler makes sense. My son sees multiple specialists for his asthma, while my daughter has always been managed by her pediatrician.

 

My son coughed for 2 years before we got sent for allergy testing and got his diagnosis, because his lungs are always clear. We didn't even notice allergies, but his allergist took one look at his nose and eyes and knew right away. The pediatrician said it was not allergies for a long time, so it's not always obvious if that's part of the problem. The Claritin seems to me like the doctor threw the kitchen sink at it, though. Has there been coughing other than when he's sick? If he coughs normally, Claritin or Zyrtec are probably worth a try. And know that one may not help at all, but another might be magic. We had to try 3 antihistamines with my son before any worked, but once we hit the right one, it truly was magic. If your son is perfectly fine and cough-free normally, I'd question adding the Claritin.

 

Sorry that got so long. We've had a long, hard road with asthma and allergies and I'm passionate about helping out other asthma moms when I can. I hope you found something useful in there!

[wapiti]

I would not avoid the oral steroids. They can be super, super helpful. (Two of my kids - 9 y.o. and 3 y.o. - spent days in the hospital on oxygen last June due to the combo of pneumonia and asthma. One of them just got put on another round of oral prednisone last week after a random checkup with the allergist showed his lung function was low and he was getting another cold. We don't want to go back to the hospital!)

 

As for what the long term situation is, I think you have to wait and see what happens afterwards, with the next cold. For the meantime, you have to get your ds better.

[sbgrace]

I really appreciate all the information shared here.

 

What's hard is he does have pneumonia. That cough is junky/wet even today. I *think* the asthmatic cough is a dry constant thing and I've only heard that in the early mornings as he wakes up and once in the middle of the night.

 

He says the inhaler helps him a little bit but only when he's in bed. That, for me, further confirms that the asthma is that dry cough that I'm not seeing much of compared to this pneumonia cough.

 

I think I'll try the prednisone anyway though based on what some of you have shared here. It may be complicating the pneumonia cough in some way and it's also possible the inhaler is only helping "a little bit" because he needs something more.

 

This child doesn't cough regularly and he's never shown a single allergy sign. His twin had cough variant asthma that later became more traditional sounding asthma as he aged. Because of that I recognized I was seeing cough variant in this child. But it just doesn't seem to be his main problem. I hope it's not permanent.

Edited October 24, 2012 by sbgrace

[SMRB]

The cough variant asthma cough isn't always dry, especially when it comes with a cold or other virus. My son (who's the worse one) only gets dry, and then later, a barky sounding cough when he's really bad and can't move the mucous any more. With my daughter, it's always a wet, junky cough, and the worse her asthma is, the junkier it sounds. At least with mine, the albuterol opens them up enough to let them cough out or spit up the junk.

 

I don't think you'll know whether it's asthma until he's over this and gets another cold. For cough variant, our pulmonologist always said that the response (or lack of response) to albuterol was the main thing they look for in diagnosing asthma at young ages.

 

I hope the prednisone does the trick for him!

[sbgrace]

The cough variant asthma cough isn't always dry, especially when it comes with a cold or other virus. My son (who's the worse one) only gets dry, and then later, a barky sounding cough when he's really bad and can't move the mucous any more. With my daughter, it's always a wet, junky cough, and the worse her asthma is, the junkier it sounds. At least with mine, the albuterol opens them up enough to let them cough out or spit up the junk.

 

I don't think you'll know whether it's asthma until he's over this and gets another cold. For cough variant, our pulmonologist always said that the response (or lack of response) to albuterol was the main thing they look for in diagnosing asthma at young ages.

 

I hope the prednisone does the trick for him!

 

When he laughs lately he has a wet/junky coughing fit (he has those at other times too). Maybe it's asthma then even though it's wet. I didn't realize that. But the wet cough doesn't appear to be responding to the albuterol. I'm not even sure the dry cough is/was. Sometimes I think he does cough more after albuterol (wet) though. Maybe it's moving the stuff?

 

It's just so far out of my experience. My other son clearly responds to albuterol and he did with cough variant too. He would have a coughing fit, we'd do albuterol, he'd sleep without coughing. Now he wheezes, uses his inhaler, and is fine. This child, though, coughs more or just as much after. He says it may help a little but even that seems uncertain when he says it.

 

I'm wondering if I should give my other son's pulmnologist a call to see this child. I don't think I know what I'm dealing with. I didn't expect to be out of my element with asthma! I guess it can be different than I thought. He's also not improving as much as I would have hoped.

 

We recently moved and I've no clue where my other son's peak flow monitor is. I wish I could find it. Maybe that would tell me a lot.

Edited October 24, 2012 by sbgrace

[SMRB]

That sounds like maybe the albuterol is opening him up a little, at least enough for it to start to move, but not enough for him to get it up/out. The steroid might do the trick then. Based on what you've said and described, I don't think anyone can say it's definitely asthma at this point. The visit to your other son's pulmonologist sounds like a good idea.