Early signs and diagnosis of childhood asthma

[american_mama]

What are the initial signs of childhood asthma and how is it diagnosed? DH is thinking that maybe DD2 has it. I am not sure she has it now, but wouldn't be surprised if she has it eventually. She gets sick more than any of the other kids. On occasions, she shows some signs of allergies to cats and pollen - itchy, swollen eyes and tighter, hoarser breathing - and on several occasions she has gotten a very bad cough accompanied bya cold where she just heaves with hacking, irritated coughs that sometimes make her gag or throw up from coughing so bad. The coughs have always been accompanied by a cold, but on Friday when she went to bed, seemingly hale and healthy, she soon started coughing like mad all night, enough to vomit a fair amount. She felt a bit under the weather on Saturday and then had an even worse cough Saturday night, tossing and turning all night (she slept with me, so I know how bad she sounded). Sunday day she again was a little sluggish, said her stomach hurt, but was coughing a lot less.

DH thinks her tight lungs sound much like his when he has asthma (which he developed a few years ago).

I am inclined to believe DD has some mild bug which has taken up its typical happy home in her throat and lungs, and it may all be exacerbated by the onset of spring. But at what point do you suspect asthma and what do you or the doctor do then?

[bubbaray]

Nighttime cough was our big indicator, plus retractions (muscles pulling in between the ribs) and tracheal tuck (which is near where the adams apple would be on a man). DD#1 was diagnosed at 13m.

GL!

[egoldber]

It could very well be asthma. That sounds a lot like my older DD. She was 5 when she was first diagnosed. At first, hers was seasonal (allergy induced) asthma, but it has gradually gotten worse. Hers is pretty well controlled with an inhaled steroid and allergy meds in her allergy season (which is basically March-August).

If she has allergies, I would take her to an allergist to get tested so you know exactly what she is allergic to. We start older DD's meds based on her particular allergen (tree pollens are different from weeds which are different from grasses, etc.). Her seasonal allergies have also gotten progressively worse every year, finding someone now and developing a relationship with them is a good thing.

The turning point for us was when she started getting persistent sinus infections in allergy season despite being on allergy meds. We were starting her meds too late in the season and she needed more than what we were giving her.

[Jo..]

DS has bad coughs following colds...they last for weeks and weeks.

Pediatrician has suggested asthma and recommended daily treatment but I am SO reluctant to believe it.

He only gets sick following colds, then has a lingering cough that goes on forever. I had the same when I was a kiddo and thought or was told I had chronic bronchitis.

His cough now (at night) is horrible. Barking.

I sooo don't want to go down the road of asthma meds. At one point we did fill an RX and DS was up literally ALL NIGHT bouncing off the walls, dancing, and singing "I'm never going to bed, I'm never going to sleep". It just seems weird to me that his cough ONLY follows colds if it is asthma. I think I need to see a specialist because I am not convinced.

Sorry to hijack.:wavey:

[jjjo1112]

For us, it was the wheezing and the retractions everytime they got a cold. Their "colds" never seemed to go away until we started using nebulizers. Also multiple chest x-rays with a diagnosis of bronchiolitis.

[bubbaray]

DS has bad coughs following colds...they last for weeks and weeks.

Pediatrician has suggested asthma and recommended daily treatment but I am SO reluctant to believe it.

He only gets sick following colds, then has a lingering cough that goes on forever. I had the same when I was a kiddo and thought or was told I had chronic bronchitis.

His cough now (at night) is horrible. Barking.

I sooo don't want to go down the road of asthma meds. At one point we did fill an RX and DS was up literally ALL NIGHT bouncing off the walls, dancing, and singing "I'm never going to bed, I'm never going to sleep". It just seems weird to me that his cough ONLY follows colds if it is asthma. I think I need to see a specialist because I am not convinced.

Sorry to hijack.:wavey:


Its called viral induced asthma and is pretty common.

If you get to an asthma specialist, the goal will be prevention/management instead of rescue inhalers (like ventolin), which can make kids hyper.

FWIW, we have had two asthma specialists now (plus my own adult one) tell me that asthma in children is very important to treat because it can lead to scaring of the lungs. My own respirologist told me that docs now treat kids more aggressively than they treat adults for this reason (which is why they start adults on a low dose med and work up, whereas the peds. asthma docs seem to do the reverse, start with the big guns and wean down).

HTH

[mamicka]

From what I know, it sounds like it's possible. I would strongly suggest talking to your doc about it & having a more aggressive treatment plan for when your DC gets sick. Forgive my unprofessional language but from what I understand, untreated respiratory issues can make an asthma diagnosis more likely later. IOW asthma-ish coughing now can damage the lungs & become asthma later.

[mamicka]

FWIW, we have had two asthma specialists now (plus my own adult one) tell me that asthma in children is very important to treat because it can lead to scaring of the lungs. My own respirologist told me that docs now treat kids more aggressively than they treat adults for this reason (which is why they start adults on a low dose med and work up, whereas the peds. asthma docs seem to do the reverse, start with the big guns and wean down).

HTH

That's more what I was trying to say. I'm tired. Thanks Melissa.

[bubbaray]

That's more what I was trying to say. I'm tired. Thanks Melissa.


LOL. Meeeeee tooo. Ironically, I think b/c I'm trying to wean down my own asthma meds (increased b/c I had a cold) too early. Sigh. I'm just beat.

[mom_of_gia]

We had a similar experience w/my 3yo daughter. I had much more peace of mind after seeing a Pulmonologist.

Good luck.

[Jo..]

Ty. I should have started my own thread but am glad I weighed in here. I will get DS to an asthma specialist.

[megs4413]

coughing is the #1 sign of asthma in children. my doc pounds this into our heads. My DD was diagnosed a little over a year ago...our big clue was that she coughed whenever she ran around, she has exercise-induced asthma. she is well-controlled now with flovent. she RARELY has to use her rescue inhaler. at first, she was using the rescue inhaler every day (when it was just her pediatrician who'd diagnosed it) and it made her terribly hyper and hard to deal with (even agressive, IMO). We got her with a pulmonologist and put her on the controller medicine and she is only using her rescue inhaler like once a month or less now. the controller medicine does not make her hyper, in fact, she takes it at bedtime. :)

i think the pulmonologist appointment was very, very worthwhile. we understand asthma better now and have a treatment plan for DD. I highly recommend taking the step to see the specialist!

[Fairy]

Both you and Jo's DCs are exhibiting classic signs of asthma. Not that classic signs always = asthma, but these that you both describe are the top indicators. Night coughing (often described as barking sounds). Heinous, non-stop, no relief coughing. At its worst, 5-10 seconds between coughs. But even at 5 mintues apart, this is not good coughing. Heaving breathing. Sucking in. Seeing bones in front or back when breathing in. Wheezing. Asthma, asthma, asthma.

Most significant, that the coughing only follows a cold, and then it lingers six times longer than the cold lasted with no further cold symptoms. Sucks beyond words. I go thru this with DS every single time he is sick. I know it's going to trigger (that's a big word -- trigger) an asthma flare. It's not that the asthma, itself, is causing the flare, it's something external, like virus or a simple sniffle, even, or an allergy that wakes up the asthma sleeping dormant in the system and makes it go off like an alarm whose snooze won't shut off.

You both will likely be on a course of nebulizer treatments, possibly kicked off by a brief course of pure liquid prednisone, and you'll be amazed how quickly your DCs will bounce back. Of course, it may not be asthma at all! Whatever it is, I wish them relief asap. I know what you're going thru. and your little guys, too. Good luck!

[american_mama]

But when do you take your child in? Now, DD2 is doing a lot better and I think might not cough during a pediatrician appt. even if I went in tomorrow. Is the other suggestion a pulmonologist? I assume an appointment there would take weeks to get, and presumably she'll be well then. Her coughing lingers for maybe a week and does not occur frequently, so how do you get them into the pulmnologist for the initial visit at a time the kid is having symptoms?

Allergists do not treat asthma, right? So an allergist visit would be in addition to a visit to the asthma specialists/pulmonolgist?

[Fairy]

Allergists are good to have in tandem with a Pulminologist, but I'd wait and start with the Pulm.

There's a diff tween active flaring and the existence of the actual condition of asthma. Most docs don't like to officially diagnose "asthma" until they're 5 or 6. For kids younger than that, they treat it like asthma, but they don't often officially say, yep, it's asthma. But really? It is.

Step 1, call your ped, and say hey, these are the symptoms, I want to be seen now, and you will be. Any active respiratory distress will be treated. They'll listen for wheezing that you may not be able to hear. They'll check for distress or at least how tight the chest is while breathing. So, that will be acutely treated, Chickie has to breathe, so forget the pulm in the near term and just get her respiratory issues treated in the here and now with your ped, step 1.

Step 2, get a referral to a pulminologist, pediatric is my preference, but some are good in general. If you're near Chicago, lemme know, I love mine. They will put DC thru a battery of breathing tests. For us with our pulm, there's this glass chamber big enough for a very big adult to fit into comfortably -- it sounds scary, I understand, but it's not, plus it's necessary -- that DC will sit in with toys in a carseat, and a computer will measure the output of the tests. They're all breathing, nothing invasive at all. This provides very clear cut data charting the breathing of the subject. They will show you graphically what the parabola of a normal person is and that of an asthmatic, and that will be the driver for the diagnosis of asthma or not asthma. Step 2.

Step 3, find out what triggers the asthma. That's when you get an allergy test. You can do the scratches, but why? Better to get teh blood test (RAST) to conclusively tell you what known allergens don't play nicely in DC's blood. Now, this is where a bit of taking my own advice comes in, as we are in this step right now. I have to get him a RAST test -- since November. I am dreading the blood draw. I do NOT want the scratches for him, yet I'm wimping out on the blood draw cuz I know what we go thru with shots, and I don't think I have the emotional fortitude to hold my child down while he's screaming bloody murder. I keep saying "today is the day!" And then it never is. Buuuut, that's this step.

Step 4, Manage the asthma long term. Just cuz I know this step is next (and really it's a transcendent step thru them all) doesn't mean I am an expert here. I am still struggling with this. He was on pulmicourt, moved to Advair, then I took him off that for a couple reasons, and have self-prescribed him back on the pulmicourt. He can't sit with a neb forever, he needs an inhaler, but I'm not warm and fuzzy on the options so far. I dunno, maybe flovent is next, I just am at wits end. For now, this is where my helpfulness stops.

I know what you're going thru. Good luck.

[egoldber]

FWIW, we have had two asthma specialists now (plus my own adult one) tell me that asthma in children is very important to treat because it can lead to scaring of the lungs. My own respirologist told me that docs now treat kids more aggressively than they treat adults for this reason (which is why they start adults on a low dose med and work up, whereas the peds. asthma docs seem to do the reverse, start with the big guns and wean down).

Yes, there is a lot of new research in this area. Also, while it seems counterintuitive, a daily dose of inhaled steroids overall gives a much lower dosage of steroids than an oral steroid scrip.

I would take her in for at least an assessment. Also, don't discount allergists. Ours is an allergy and asthma specialist, which is pretty common here.

[nov04]

Its called viral induced asthma and is pretty common.

If you get to an asthma specialist, the goal will be prevention/management instead of rescue inhalers (like ventolin), which can make kids hyper.

FWIW, we have had two asthma specialists now (plus my own adult one) tell me that asthma in children is very important to treat because it can lead to scaring of the lungs. My own respirologist told me that docs now treat kids more aggressively than they treat adults for this reason (which is why they start adults on a low dose med and work up, whereas the peds. asthma docs seem to do the reverse, start with the big guns and wean down).

HTH

This is exactly me! I went undiagnosed as a child for years even though we regularly went to our FP for coughing and symptoms of asthma in the mid '80's. Now I *always* have problems each winter and with every cold. I even had 2 lung infections this winter. A few years ago I was prednisone a few times in one year which means asthma isn't controlled well. I'm sure I'll always have asthma.

OTOH, dd2 is on twice daily flovent (steroids) from august to april as per our wonderful ped (started last august). We have an action plan when she develops a cold which we follow to the letter. This is a far cry from a year ago when she had pneumonia and a partially collapsed lung and bronchiolitis the year before.

I'm so thankful that asthma is managed so much more aggressively these days.

[bubbaray]

Also, don't discount allergists. Ours is an allergy and asthma specialist, which is pretty common here.


:yeahthat: The girls' specialist at Children's actually has dual specialties. The clinic is the Allergy & Asthma clinic. I like the one-stop shopping, personally.