sbgrace Posted December 2, 2012 Share Posted December 2, 2012 Is there a way to avoid oral steroids in a viral induced asthma flair? This child never had asthma until he got pneumonia in early October. He's been coughing ever since. My son finished up a round or oral steroids less than two weeks ago. He got a new virus and now is back in a flair. Our pediatrician was very unhelpful even though I took him in the very day he started getting sick again (when the asthma was just starting and only on waking) asking for some help to keep it from getting bad. All he said was do more oral steroids for control though he didn't hear any asthma in office. I'm just sick about it. I'm not getting complete control with two puffs of albuterol I don't think. He has a cough. I can hear a whistle when I put my ear on his back. No audible wheeze. That cough, though, can be constant. I didn't know I could give more than two puffs until this morning. I think it would take more than two to get rid of that whistle. But I have no instruction about what to do and how long. Can I pull him out of this with a combination of albuterol and wait for the virus to leave or are we doomed to oral steroids again? Is there anything else I can do? How bad for him will two almost back to back rounds of steroids be? I'm really, really upset about this. Quote Link to comment Share on other sites More sharing options...
Karen A Posted December 2, 2012 Share Posted December 2, 2012 The rule of thumb is 2 puffs albuterol every 4 hours is fine. Using a spacer is best for actually getting the med properly inhaled. If you have a nebulizer, I think it works even better--one vial albuterol (3mL) every 4 hours. When my dd starts wheezing, the doctor prescribed an "asthma action plan" in which she can have 2 puffs every 20 minutes for an hour, if she is still wheezing, and then go to the every 4 hours. Does he have inhaled steroids or other asthma meds to take? Quote Link to comment Share on other sites More sharing options...
sbgrace Posted December 2, 2012 Author Share Posted December 2, 2012 I've got albuterol with a spacer (mask type) and oral prednisone. I didn't know I'm supposed to wait a minute or so between puffs. I read that online. Is that your instruction too? I wish I had known I could give more than two puffs in an hour when this first kicked off. This morning he woke coughing. I did two puffs. He was still coughing (with that whistle heard on his back) 30 minutes later so I did another two puffs. That took care of the whistle and cough for a while. I think it's the first time in all of this we really got any measure of control. Quote Link to comment Share on other sites More sharing options...
LMV Posted December 2, 2012 Share Posted December 2, 2012 A few thoughts: -If your son hasn't been re-evaluated recently that would be a good idea. The decision of whether he needs another round of systemic steroids should be made by that physician after getting a good history and examining your son. -A Chest X-ray now to exclude pneumonia and pertussis testing may also be reasonable depending on the full clinical scenario. -Asthma is usually a combination of bronchospasm (which causes cough and or wheezing) and inflammation. The albuterol helps with the bronchospasm but without something to address the inflammation it can be hard to break the cycle for good. This is the rationale behind using a burst of systemic steroids and also the rationale behind using maintenance medications like inhaled steroids to help keep the inflammation in check and help prevent future flares. -Inhaled steroids have very little systemic absorption and thus many of the concerns with systemic steroids are not relevant here (or if relevant to a much lesser extent). For many kids having good maintenance control will help avoid exacerbations and reduce the number of systemic steroid courses they need. -Did your pediatrician ever get PFTs? -If your son hasn't had a flu shot you may want to consider this as influenza will also likely trigger his asthma and he is also more likely to have influenza complications Quote Link to comment Share on other sites More sharing options...
butterflymommy Posted December 2, 2012 Share Posted December 2, 2012 He may need a daily preventative for a while, like pulmicort. You can always wean him off of it later down the road. Don't be afraid of steroids to treat asthma because asthma, especially severe asthma, is much more dangerous than steroids. My DD nearly died from asthma and was in the ICU for a week plus another week in the ward from severe viral asthma. The main problem is that steroids can stunt growth when used long term, but as I said you can try weaning him in the future. My DDs usually have daily pulmicort then albuterol when they are sick and audibly wheezing. Dr has said I can give albuterol every 2 hour in am emergency. Also prednisolone can be used to avoid the hospital. Don't always depend on audible wheezing, abdominal retractions without audible wheezing actually means the person is in severe respiratory distress. So check his stomach too when he's sick. There are videos of reatracting online if you don't know what it looks like. I know all these meds sound scary and dangerous but they could save your son's life. And like i said you can always wean off them. Quote Link to comment Share on other sites More sharing options...
sbgrace Posted December 2, 2012 Author Share Posted December 2, 2012 He was seen last week-end. The pediatrician didn't hear asthma in the cough. They did a chest x-ray (clear). The did a pertussis screen (no results yet). They didn't do anything to keep us from winding up right back where we are now after the last round of oral steroids. What are PFT's? I don't have a peak flow monitor and the pediatrician only did oxygen saturation rates when we've been in. Quote Link to comment Share on other sites More sharing options...
LMA Posted December 2, 2012 Share Posted December 2, 2012 I don't understand why you think the steroids are "evil." The steroids help with inflammation inside the lungs, which can hamper breathing. (They are not anabolic steroids, btw.) If you don't understand, ask the doctor how the steroids will help your son. You don't want your son to have labored breathing and that could come up with his virus. Sometimes it will take a long time for the cough to go away, sometimes weeks. If the cough sounds bad, please take him back in for another evaluation. Quote Link to comment Share on other sites More sharing options...
LMV Posted December 2, 2012 Share Posted December 2, 2012 He was seen last week-end. The pediatrician didn't hear asthma in the cough. They did a chest x-ray (clear). The did a pertussis screen (no results yet). They didn't do anything to keep us from winding up right back where we are now after the last round of oral steroids. What are PFT's? I don't have a peak flow monitor and the pediatrician only did oxygen saturation rates when we've been in. Am I understanding this your son's course: -October 2012 Pneumonia/Asthma treated with antibiotics, systemic steroids, and albuterol -Cough persists -Last week seen by pediatrician and given more systemic steroids and albuterol [did he take the steroids?] -Now still coughing and wheezing It sounds like he may need maintenance medication like an inhaled steroid he takes daily or maybe even twice daily. (The pulmicort mentioned above is an example of an inhaled steroid available for use with a nebulizer---it is great for younger kids who may have trouble using a steroid inhaler. There are also several inhaled steroids available in inhaler/discus forms and if your son is eight he may be able to use one of these.) PFTs are Pulmonary Function Tests. They can measure inspiratory/expiratory capacity, air flow rates, lung volumes, diffusing capacity (although not all centers will do this). Your son blows into a device that measure and outputs the data using computer software to generate loops and curves. Quote Link to comment Share on other sites More sharing options...
blondeviolin Posted December 2, 2012 Share Posted December 2, 2012 The doc could even prescribe a plan where you would start inhaled steroids when you notice a flair happening. Inhaled steroids are topical basically and can really help without having to deal with oral side effects. Quote Link to comment Share on other sites More sharing options...
brownie Posted December 2, 2012 Share Posted December 2, 2012 All kinds of ways! Your ds should be on a maintenance med. The simplest is probably Singulair. When we started, we tried just using it at the onset of a cold for 10 days, but then had to go to daily. We also used Intal (an old drug) 4x a day to avoid steroids all together and then went on the mildest steroid available via inhalation for maintenance, but I can't remember it's name anymore. Caffeine is also a helpful boost in controlling asthma. Sounds like you need an allergist or pulmonologist! We were told rule of thumb was once a kid had oral steroid 3x in a calendar year, they needed daily inhaled steroid for prevention. We did everything in our power to avoid that for as long as possible too. Now my oldest is off all meds and never has an attack! He was in the ER a lot as a toddler/preschooler. BTW he also swims which I feel has helped as well. He has tremendous lung capacity which probably would "disguise" any super minor flare ups because he has no trouble getting plenty of oxygen. An allergist should be able to measure lung capacity in their office...kind of like comparing a kids growth to a growth chart. Brownie Quote Link to comment Share on other sites More sharing options...
sbgrace Posted December 2, 2012 Author Share Posted December 2, 2012 I think I do need pulmunology yes. I don't think steroids are evil. I'm frustrated that we are possibly headed toward our 2nd round of oral steroids in just two weeks. I am particularly concerned about the effects of steroids on growth (my son is less than 5% weight and height) and that it might further depress an immune system already a mess. I asked the office to put him on Singulair or some other maintenance medication before we got another virus induced asthma cycle and they didn't want to do that. And here we are. So I feel he was mismanaged all along. I also think I messed up. Anyway, what I'm really hoping is we can avoid a second closely spaced oral steroid round. At this point all the office will do is inhaled advair (?), albuterol, antibiotic (no known infection), and oral steroids. I feel like that's a sledge hammer for maybe something that could take a tap instead. So I'd like to get him through this virus and stable enough to go back in and plead my case again for a maintenance med to try to keep this from being an endless cycle of oral steroids with every single cold. Brownie, that's very helpful. I wish I could get the pediatrician to listen to me. We're new here and I don't like him. I don't feel I can go to another in the practice though given we're in the middle of this episode. Quote Link to comment Share on other sites More sharing options...
wapiti Posted December 2, 2012 Share Posted December 2, 2012 . Quote Link to comment Share on other sites More sharing options...
blondeviolin Posted December 2, 2012 Share Posted December 2, 2012 You might try the advair. It's a maintenance med. It's a cocktail of an inhaled steroid (to attack the inflammation) and a long-acting bronchodilator (for the tightness). It's a very mild drug compared to prednisone and could get him over the hump, so to speak. But yes, definitely see an asthma specialist! Quote Link to comment Share on other sites More sharing options...
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