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View Full Version : Update and Thanks. Infants and asthma (Sorry, Long)



juliasmom05
11-09-2005, 03:58 PM
UPDATE: Thanks everyone. Unfortunately we didn't have much of a choice with the drugs. The oral steroids work much quicker than the inhaled kind. She got worse on Thursday morning and even after 4 back to back doses of albuterol in the pedi's office her breathing was still very labored and her Oyxgen sat. levels were way too low. We had to admit her to the hospital. Very stressful for me but she has been a trooper. They call her the "happy wheezer". Luckily she is doing much much better and hopefully she will be discharged today. Thanks again for all the advice.


Our pedi just told us that he thinks DD has asthma. She had been coughing sporadically ever since she had a cold a couple of months ago. Over the last couple of days, she started coughing more and began to wheeze yesterday. I have a history of bronchial asthma, bronchitis, allergies and pneumoniae but I am shocked to be dealing with this when she is only seven months.

I unfortunately had to leave the doctors appointment early this morning because I had to teach a class, but DH told me that the pedi thinks it is asthma (I can't remember the other term that was used) due to family history of asthma, the chronic cough, the wheezing and the fact that her breathing sounds improved with a single dose of albuterol in the doctor's office.

The pedi prescribed albuterol (with a nebulizer) and an oral steroid (prednisolone). Both short term. And amoxillicin, because she also has an ear infection. Both DH and I are not to keen givng DD steroids, especially the oral steroids, when she is so young. DH questioned the pedi about alternative treatments, but the pedi said that this is standard practice to treat it aggressively with steroids.

So, although I want to research this further, I don't really want to wait to treat her because she is so miserable right now. She's not sleeping, her breathing is labored, she is refusing the bottle at daycare, and also just refused to nurse this afternoon.

We have another appointment tomorrow so I can ask some more questions of the pedi, but right now I was wondering whether anyone's DC were diagnosed with asthma as infants? Is it common practice to treat so aggressively? Are there alternative treatments? Do you wait until another episode to seek out a respiratory or allergy specialist? Are there long term effects of short term steroid use in infants?

Thanks for any advice you guys can give me. I am sort of freaking out at the moment.

Marci

Mom to Julia 4/05

MommytoDylan
11-09-2005, 04:18 PM
Replying quickly so let me know if you want more detailed information. I was told during our experiences (both children have been hospitalized due to breathing issues) that it is first called bronchilitis and then if it appears over and over for a certain amt. of time they finally call it asthma. My son had wheezing episodes everytime he got sick and was given breathing treatments in the doctor's office. When it got bad enough that we were admitted to the hospital, they still just stayed with breathing treatments every few hours and some oxygen as needed. They didn't give an oral steroid until it got worse. He was so weak at that point that he just laid in my arms for 2 days straight hooked up to oxygen. I felt we were very close to him being on the vent. We left the hospital a few days later with a neubulizer, an oral steroid prescription, and a diagnosis of asthma. Once he was well he had inhaled steroid treatments twice a day as a precaution. When he was sick we sometimes did 5-6 treatments a day. I even got a medical baseline allowance (discount) on my energy bill! I then put him on a nutritional supplement and took him off all medicines. He's been healthy for over a year since!!

My daughter was hospitalized at 4 months with bronchilitis. They did regular breathing treatments, an oral steroid, and sent us home with no asthma diagnosis. She is now 5 months old and I wouldn't be surprised if she follows in her brother's footsteps.

So many doctors have told me that often it is something a child outgrows so they stick with the bronchilitis label or even reactive airway disease until much later if it is still an issue. They also have all said that studies don't show a clear benefit to the use of an oral steroid.

Hang in there, mama!! I know breathing issues are such scary stuff! Sounds like your little one is getting the medical attention she needs!

HTH,
Meredith

kensjen
11-09-2005, 04:41 PM
We also went through this...well, we still are. This is the bad time of year.

They officially diagnosed my son before he was a year old, don't remember exactly when. Before that, we had been to the ped frequently for colds, upper respiratory infections,etc. Jonah always ended up wheezing anytime he was sick, and we figured it was asthma. DH's family has a history of asthma, so we weren't surprised.

Jonah's is very mild, really it is just triggered by a cold or something like that. I know some children have other "triggers" like pets, dust, other allergens...maybe you will notice what bothers your DD so you can help her to avoid it.

We have used prednisolone twice, usually our Dr only prescribes that when he feels it is really necessary. It is standard practice to give prednislone, our ped just has always been cautious when prescribing any meds with our son, especially when he was really young. Your daughter sounds miserable, and like she could use the meds. I understand your concern, I felt the same, but didn't find any info that made me not want to use the steroids. There is a difference in just a day or two with Jonah and his breathing when he takes the meds. We also had a scare last year and he ended up in the hospital for 2 days, which was terrible (mostly for me). I don't want to let it get that bad again, so I trust my ped anytime he wants to medicate.

We are also the proud owners of a nebulizer, so if he does get bad we can treat him right away at home. We have a standing Rx for albuterol. Our insurance paid for everything, the compressor and all, and it has given me peace of mind on many occasions. A treatment or two always makes a big difference. There is nothing as scary as watching your child try to breathe...when it is labored. :(

We have decided not to go on any preventative meds, that would be the next step if he has any bad episodes. (now that he is over 2) We never needed a specialist, I completely love and trust my ped with this. After talking with your ped tomorrow, if you still feel uncomfortable you can always ask to be referred to someone. Especially if you don't feel it is a "mild" case. I think that is part of why I am fine with my ped, Jonah's asthma definitely is mild, hasn't been life threatening. I am hoping that he will outgrow it like his father did.

I hope that was a bit helpful, I am just typing things off the top of my head. Please LMK if you have any other questions. I am not a Dr., but have had a lot of experience with these breathing issues.

Hugs mama!

lisams
11-09-2005, 04:54 PM
The steroid is short term, and will not hurt/harm her - DD had to take it last winter. It helps shrink the swelling in the lungs so the albuteral can get deeper into the lungs to really work. If it were long term then I would be concerned.

Try not to worry at this point, it could very likely be what DD had last winter - viral "asthma"/RAD, basically she gets the symptoms when she gets an upper respiratory infection or virus. RAD is a term, I think it stands for reactive airways disease, which is a new label they use in children, instead of labeling them with Asthma at such a young age - I guess many children outgrow it plus there are some insurance issues if they are diagnosed with asthma early on and it turns out to not really be - it's hard to get rid of that label.

As you know, it's important to get her breathing easily ASAP and the treatment the dr. gave you is right on, IMO. DD was hospitalized twice this past winter, and I saw how dangerous letting her go too long without treatment is. Did they take an X-ray to rule out pneumonia? If her breathing stays labored, or she is "retracting" which means below her ribcage she is pulling in with each breath take her back in ASAP or head to the ER.

Good luck, and I hope she is feeling better soon. I'm guessing once you start the treatments she will be breathing easier.

ETA: Yes, try to push for getting a nebulizer machine that you keep at home, and some back up refills of albuteral to have on hand at all times (insurance covered our machine). DD is just now getting over a cold and being able to give her a few breathing treatments of Xopenex (same as albuteral but makes DD less jittery) helped her out. We just have to be careful and start treating her right away when she gets a cold or any other respiratory infection.

californiagirl
11-09-2005, 05:39 PM
Our ped, in a similar situation, 1) refused to call it asthma, saying that it's very common for infants to have breathing problems only when they also have infections and that they tend to outgrow it, and it's not useful to label it asthma (even though I have the same issue at the ripe old age of 40) and 2) prescribed INHALED steroids, not oral steroids.

I would ask for a nebulizer and inhaled steroids, which have fewer side effects.

lisams
11-09-2005, 07:00 PM
We've gone both routes as far as the steroids go and I have to agree that inhaled is better. It seemed to work better, at the time you need it most. You give it first with the machine, to open the bronchial airways and then use the albuteral. This way it is able to go deeper since it opens up the airways, the disadvantage is it takes longer since you have to do the two treatments one after the other.

Good luck!

californiagirl
11-09-2005, 07:06 PM
Other way around! Albuterol first (it opens airways immediately) then steroids (they have a long-term effect).

And yes, it is a pain; the steroids are slower, too.

lilycat88
11-09-2005, 09:22 PM
We've done both inhaled and oral steroids as well. DD develops a cough as her first ear infection symptom as well as any time she has a cold. The only time we did the oral steroids was during a bout of croup. Her ped has never even mentioned asthma even though we have a nebulizer at home and immediately start albuterol as soon as a cough develops. The albuterol makes a world of difference and we usually only have to do them for about a week. We've only done inhaled steroids 2-3 times. One thing we were able to do (her ped suggested it) was to get the non diluted steroid mixture (not the kind already in a premixed vial) and mix it into the albuterol. That decreases the amount of time required to administer both treatments since the fluid volume is lower. The steroid has to be suspended in *something* and that *something* is water in the vials but the *something* can just as easily be albuterol. I'm sure there is some benefit of having the entire albuterol treatment onboard before the steroid but this method worked for us and we couldn't tell any difference in efficacy.

Jamelin
Mom to Susanna born 6/29/2004

smilequeen
11-09-2005, 09:41 PM
Simon has infant asthma or reactive airway disease (depends on who I talk to). Started at around 4 months. Similar to you...a cough that would never leave after a cold.

We treated first with Xopenex by nebulizer (ask about this, it is supposed to have fewer side effects than albuterol), then we added pulmicort which is an inhaled steroid, then we added oral Singulair. The Singulair was the key for us. He still coughs when his allergies act up or when he isn't feeling well. We have Xopenex still for coughing fits. I am hoping to get him off the pulmicort soon.

Honestly, a neb is tough with a baby, so I would have preferred doing a short term oral steroid with him.

Lynnie
11-09-2005, 10:03 PM
ditto on just about all of the pps. DS1 got bronchiolitis/rsv his first week at a daycare when he was 5 1/2 months old, and has since been diagnosed with asthma. We too went the nebulizer, occasional doses of prednisone, albuterol to xopenex, the pulmicort inhaler pump thing, and singulair route. (not all at once, mind you, just over the past 3 years). He is currently on singulaire, once per night and I have one nebulizer at school and one at home to give him when he starts coughing too much (And a spare I had to buy when our flight from wilma left us in DC about a week longer than we had planned and the boys got sick). He has never been hospitalized, thankfully, and in addition to keeping him on the singulair, I am looking into getting some natural vitamin and nutritional supplements that a colleague swears by.

I have read that asthma is alot more common these days. Several kids at DS's school have nebulizers too.

I was worried about the steroid use, especially the orapred (prednisone) but I trust my ped, and he reassured me that short term use was ok, and necessary when the neb wouldn't take care of the problem. However, if he doesn't "outgrow" the condition - and I am ignorant as to when he should if he is going to, if ykwim, I may take him to a specialist for more peace of mind. As much as I respect and trust my ped, a specialist has to be so much more on top of this.

Hope DD feels better soon.

Lynn

PS Let me know if you'd like an older model, no frills nebulizer... we really don't need to own THREE ! seriously, or I guess I'll donate it somewhere to help out a family - wonder who would take that kind of donation - and if it would be sterile enough. I think so, since the air is blown out from the machine, and you'd get new tubing, but it could be kind of yucky getting one from a stranger. although in the dr.'s office, they don't have disposable machines, all kids "share" the same one - sorry for rambling !

dr mom
11-09-2005, 10:06 PM
An oral corticosteroid will work more quickly than an inhaled corticosteroid to relieve symptoms - a standard course of treatment might be 5-10 days of prednisolone, it's not something that would be an everyday "chronic" med. If this is what your ped decides to do, I recommend you ask for brand name Orapred instead of Pediapred, which tastes nasty. It costs more, but it is SO worth it when you're trying to wrestle it into the baby.

Most peds won't diagnose asthma before 2 years of age - all infants have small airways, so wheezing or coughing during illness is fairly common. I think "reactive airway disease" would be a better diagnosis at this point, because many children outgrow it. Asthma is more of a chronic disease. I wouldn't put that label on your DD at this point, until you know whether her symptoms are in fact chronic. (Some kids outgrow asthma, too, but that's the exception and not the rule)

It's true that nebulizer treatments are tough with babies, but the more they yell and cry and fuss, the deeper they're pulling the medicine into their lungs. Easy for ME to say, since I'm not the one holding the wiggling, enraged infant! The alternative is using a face mask with a spacer - this is what I use with DS, who only has very mild symptoms - but for kids who have lots of wheezing or difficulty breathing I think the neb is still the best way to go. Because the treatment lasts longer, there's more opportunity for the medication to be pulled deeper into the lungs. Albuterol first, then steroid.

Xopenex is the active isomer of albuterol. It is more lung-specific and doesn't have as many cardiac side effects as albuterol, which can cause a transient rapid heartrate. It is considerably more expensive than generic albuterol. I use Xopenex for anyone with heart disease or multiple medical issues, but for most healthy kids, albuterol works just fine.

Inhaled steroids are felt to be generally safe in infants and young children, with the caveat that there may be some long-term effects on growth. This is controversial, and the data isn't conclusive. Children on long-term steroids (years not weeks) may end up slightly shorter than their peers. Obviously, if your DD improves after oral steroids and doesn't need to be on chronic medication, you wouldn't want to give her something with potential side effects. But, whatever you call it at this age - asthma, wheezing, reactive airway disease, bronchiolitis - bronchospasm has the potential to be very serious, even life-threatening. Kids die of asthma. I'm not saying this to scare you, just to help put into perspective that medication side effects aren't the only factor you need to consider. Of course you will want to reassess your DD's health with her pediatrician on a regular basis and re-evaluate what is best for her. If you aren't sure you know what is best for her, ask for a second opinion and talk to a pediatric allergist or pulmonologist.

Be forewarned: the side effects of albuterol and oral steroids will have your DD bouncing off the walls.

lilycat88
11-09-2005, 10:31 PM
AMEN to the Orapred!
Also, the nebulizer treatments get better. At 16 months, Susanna sits in my lap and holds her own mask.

Jamelin
Mom to Susanna born 6/29/2004

ctmom
11-10-2005, 08:18 AM
just as a side note, a few weeks ago my 22mo had another virus that quickly turned to breathing problems and the dr prescribed albuterol, with a nebulizer, and prednisone orally for a few days. She then prescribed pulmocort via nebulizer. Well after about a week I was at my wits end with the nebulizer. DD HATED THE NEBULIZER!! It got to the point I was strapping her, via a 5 pt harness, into her highchair and trying it that way. Not fun!! Since the dr wanted her to do steroids twice a day, for a month, I called and asked for advice. She prescribed an AeroChamber with an inhaler of flovent and also albuterol with the inhaler just in case I needed it. My life has been much better!! I don't know how old a child has to be for the AeroChamber, but I wanted to throw this option out there for anyone whose child doesn't tolerate the nebulizer very well. The treatments now take seconds instead of 15-20 minutes...We also have an appointment with a pediatric pulmonologist next week for another opinion.

juliasmom05
11-12-2005, 08:33 AM
Thank you. Definitely very helpful. We did decide to give her the oral corticosteroids, but unfortunately it was too late. She also spit out more than half of the dose so that didn't help either. We too had to go to the hospital. Luckily only for one night since she improved very quickly. We are going to talk to the pedi about preventative measures next week. Hopefully we will not need them but I want to be informed just in case.

Marci

Mom to Julia 4/05

juliasmom05
11-12-2005, 08:34 AM
Got the nebulizer machine so now hopefully that we are aware we can treat her next time before it gets this bad. Thanks again.

Marci

Mom to Julia 4/05

juliasmom05
11-12-2005, 08:38 AM
oops.

juliasmom05
11-12-2005, 08:40 AM
She is already on the albuterol and I hestitate to switch meds right in the middle, but will definitely ask about Xopenex at the pedi office next week. At the moment she is not too jittery and is still sleeping ok. Thanks.

Julia screamed and screamed with the nebulizer the first couple of times. She screamed until she was so exhausted at the pedi that she fell asleep during the last treatment. Now, after several more treatments she is much more calm and seems to tolerate it much more. We just have to follow her around with the nebulizer as she keeps turning her head. Thanks again.

Marci

Mom to Julia 4/05

juliasmom05
11-12-2005, 08:48 AM
Thank you so much for your response. It was very reassuring. We do trust our pedi and ended up giving her the oral corticosteroids. Unfortunately, just a little too late. After talking with the pedi some more, he reassurred me that oral steroids would not be the first line of treatment for every subsequent episodes (if there are any) because there are preventative measures that we can take. We will definitely keep reassessing her health on a regular basis and are hoping that it doesn't get too severe. But at least now, we are aware of what can happen.


We did get the orapred, but unfortunately it is difficult to give it to her. She justs spits it out and cries hysterically. We are getting better at giving her her meds,so I think we are now getting most of it in. I am glad it is only for 5 days.

Thanks again.

Marci

Mom to Julia 4/05