Update: Asthma ? : Difference between Micro chamber and Air Chamber?

[artvandalay]

Update in post 7



DS's doctor is ordering him an inhaler (I think he said Advair) with an air chamber. He told the pharmacist to specifically not give us the Micro-chamber, but an air chamber without a face mask.

We already have a Micro Chamber at home because DS did a trial run of an inhaler a couple of years ago. I remember it costing about $25, so I would rather not spend another $25 on an air chamber.

The pharmacist remarked that it was sort of odd, she said that they use the micro chamber and air chamber interchangably (sp?), so she didn't see why we couldn't use the Micro chamber, except that he specifically put in the order we should not use one.

Can anyone clear this up for me? Thank you.

[Kindra178]

Isn't the Microchamber smaller and expandable? My doc hates it too, by the way. I think the shorter length defeats the purpose of the spacer. I also think the mask is necessary for a kid.

On another note, are you sure it's Advair and not Flovent? I didn't think little kids can get Advair (and I don't think I would feel comfortable with giving a little kid Advair, even though I take it every day for the past 12 years and took it while pregnant).

[artvandalay]

Isn't the Microchamber smaller and expandable? My doc hates it too, by the way. I think the shorter length defeats the purpose of the spacer. I also think the mask is necessary for a kid.

On another note, are you sure it's Advair and not Flovent? I didn't think little kids can get Advair (and I don't think I would feel comfortable with giving a little kid Advair, even though I take it every day for the past 12 years and took it while pregnant).

It's definitely Advair. I'm looking at the box. It says Advair HFA 12 GM. My son is 7. The pharmacist didn't mention it would be a problem for him.... but I'm concerned about your concerns with Advair given to kids. I'll look up more info on it tomorrow. The micro-chamber is not collapsable (at least ours isn't).

Turns out the pharmacy where DH picked up the Advair didn't have the air chamber in stock. Also, the doctor didn't order the mask to go with the air chamber, so the pharmacist commented it was odd that he specifically did not want us to have the micro-chamber, but that he didn't want him to use the mask with the air chamber.

We just gave him the Advair with the Micro Chamber anyway, since the pharmacy was out of stock. I am supposed to call the dr. back in the morning, so I"ll ask him his reasoning.

Thanks for your reply, Kindra :)


ETA: Oops, sorry, the actual dose is: fluticasone propionate 45 mcg and salmeterol 21 mcg

[Kindra178]

It's definitely Advair. I'm looking at the box. It says Advair HFA 12 GM. My son is 7. The pharmacist didn't mention it would be a problem for him.... but I'm concerned about your concerns with Advair given to kids. I'll look up more info on it tomorrow. The micro-chamber is not collapsable (at least ours isn't).

Turns out the pharmacy where DH picked up the Advair didn't have the air chamber in stock. Also, the doctor didn't order the mask to go with the air chamber, so the pharmacist commented it was odd that he specifically did not want us to have the micro-chamber, but that he didn't want him to use the mask with the air chamber.

We just gave him the Advair with the Micro Chamber anyway, since the pharmacy was out of stock. I am supposed to call the dr. back in the morning, so I"ll ask him his reasoning.

Thanks for your reply, Kindra :)


ETA: Oops, sorry, the actual dose is: fluticasone propionate 45 mcg and salmeterol 21 mcg

I wasn't trying to get you worried. I don't have a 7 year old asthmatic (only a 5 year old and 2 three year old asthmatics and a 39 year old asthmatic (me!)) but I am surprised that Advair is the choice. Salmeterol is controversial. There have been people at the FDA that have wanted it banned (David Graham is one). I just didn't think it was given to kids, but maybe that's because my kids aren't old enough. For me, Advair is the only thing that keeps me off steroids consistently.

[egoldber]

FWIW, my older DD has been on Advair for several years and it works very well for her. It is not considered a first line med (generally Pulmicort or Flovent are preferred initially), but in her case something like Flovent was not sufficient by itself.

She switched to the Advair disk about 1 year ago she much, much prefers that to the air chamber. In the past, she has used both the air chamber with and without the mask.

The concern about salmeterol is that it is a LABA (long acting beta agonist) and some studies have shown a small increase in side effects when LABAs are used alone, and not with an inhaled steroid. But by definition, Advair contains both a LABA and a steroid, so honestly my DD's allergist said he never even understood the FDA's reasoning in putting a black box label on Advair. The studies showing an increased risk from LABAs did not study the use of Advair at all.

[artvandalay]

I am really stressed out about DS's coughing. It seems no one can figure out if his severe coughing is a result of allergies, reflux or perhaps asthma. His allergist asks me all the time if he coughs or is SOB on exertion/exercise, which he is not. The allergist put him on two reflux meds on Monday, in addition to his 2 allergy meds.

He has not tried other inhalers recently. He tried one a couple of years ago for a short duration, but we discovered his coughing was due to his allergies, and quickly stopped the inhaler. This allergist put him on Advair last night, and he does not have uncontrolled asthma (as far as we know) and has not been given other inhalers as a first choice by this allergist. The allergist performed breathing tests on him and determined from the first visit that he didn't have asthma, so I'm scratching my head at all of this.

I called the pharmacist last night. He said he did have a few children under 12 on Advair. He said it is used for pretty severe, uncontrolled asthma in children. I think he was surprised to hear my DS has not tried other inhalers first.

I did read about the warnings (long acting-beta agonists). Thank you Beth for your imput on your child's experience.

The allergist asked me last night to call him this morning and give him an update. I am awaiting his call and we will go from there. I am so frustrated.
Cough is slightly less severe, but he is still coughing every 2 to 3 minutes.

[artvandalay]

Just spoke with the allergist. He said he believes the air chamber works better for children. He said perhaps the reason he is not much better today is that he didn't recieve enough medication from the micro chamber.

I talked to him about my concerns with Advair. He said he has 4 year olds on Advair. He said the proper studies weren't done on this medication with children, and not to worry.

He advised me to give DS something with Dextromethorpan, and call him this afternoon. If he is not better, he will give him an oral steroid.

DH just left to try another pharmacy that has the air chamber in stock. Fingers crossed something works.

[egoldber]

Inhaled steroids need time to work. It can take 3-4 days to see improvement. I am somewhat surprised he wants to jump right to an oral steroid, since the general protocol is to try and avoid them if at all possible.

Air chambers work well with children, but I do think that older DD gets much better dosing with the disk than she did with the inhaler and spacer combo.

[Melaine]

Subbing in for info. DD2 just got an official diagnosis of asthma this morning (though I've been pretty sure for a couple years now). They gave her albuterol with the little tube and mask thing.

[Kindra178]

Inhaled steroids need time to work. It can take 3-4 days to see improvement. I am somewhat surprised he wants to jump right to an oral steroid, since the general protocol is to try and avoid them if at all possible.

Air chambers work well with children, but I do think that older DD gets much better dosing with the disk than she did with the inhaler and spacer combo.

I'm surprised Singulair wasn't tried first (which is for allergies and coughing/asthma) and then Flovent 44 or even 110 added before Advair. I also don't know he declared your child didn't have asthma (I am not saying he definitely does, but there is no definitive test). Plus, many people have cough variant asthma and don't wheeze until they are really in trouble (like me and two of my guys). Finally, there is no way that Advair would have worked with one dose administered.

[Kindra178]

Subbing in for info. DD2 just got an official diagnosis of asthma this morning (though I've been pretty sure for a couple years now). They gave her albuterol with the little tube and mask thing.

They didn't put her on a control medicine?

[egoldber]

Plus, many people have cough variant asthma and don't wheeze until they are really in trouble

Yes, this is what older DD has a well. She has allergy and cold/viral induced asthma.

[artvandalay]

I'm surprised Singulair wasn't tried first (which is for allergies and coughing/asthma) and then Flovent 44 or even 110 added before Advair. I also don't know he declared your child didn't have asthma (I am not saying he definitely does, but there is no definitive test). Plus, many people have cough variant asthma and don't wheeze until they are really in trouble (like me and two of my guys). Finally, there is no way that Advair would have worked with one dose administered.

I honestly don't know why he started with Advair. He was seen in the office Monday for cough. The allergist wanted to know when he was coughing. I told him it's mostly at night and in the morning. He wasn't coughing that much during the day. He derived from that that might be coughing from reflux. He listened to him and didn't hear any wheezing. He also has many allergies, but he didn't think this was allergy related. He doesn't have any cold symptoms.

He said the reflux medications should help and to come back in 3 weeks. He progressively got worse through the week, and yesterday his teacher sent him to the nurse because he was coughing so violently. He was coughing very severe last night, coughing in jags every 2 to 3 minutes.

When I spoke to the allergist today he honestly sounds a little unsure of what was going on.

He does seem to be a bit better right now (after getting Mucinex DM that the doctor recommended.) He is still coughing frequently, but they don't appear to be in jags like last night.

Oh, he did receive two doses of the Advair (last night and this morning).

I did record a few seconds of him coughing on my iphone because I was worried DS wouldn't be coughing when the doctor called, and I wanted to play his cough for him.

I could post it here if anyone can give me any thoughts, although I really don't know if that is even possible to post a video here. Sorry if this sounds jumbled and if I repeated anything.

[Melaine]

They didn't put her on a control medicine?

No, she is usually ok, right now she has a virus... she also seems to have allergy/illness or exercise induced symptoms. I wouldn't have wanted her to be on something every day at this point. My asthma is the same way....usually I'm ok but I get flares when sick or sometimes when exercising although the more I exercise the more I seem to be able to tolerate exercise. I was just afraid to exercise much for years because of the symptoms. Anyway, I'm hoping this will get her through the worst of it. I do think I need to take her to an allergist though sometime soon.

[Kindra178]

Thanks for the update. From experience, I suspect you will see the onslaught of cold symptoms in the next couple of days. For some reason, coughers/asthmatics start with the coughing/wheezing a few days before a cold virus takes over. I have seen this again and again with myself and my kids, especially my oldest.

One more thing. Just because he hasn't wheezed in the past doesn't mean he (1) he won't wheeze in the future and (2) this coughing won't turn into wheezing. Clear lungs on Monday might not mean clear lungs this week. And in an allergic kid, wheezing/asthma is so closely linked. It's all part of reactive airway syndrome.

[noodle]

Plus, many people have cough variant asthma and don't wheeze until they are really in trouble (like me and two of my guys). Finally, there is no way that Advair would have worked with one dose administered.

:yeahthat:
to both of these points. We treat at the first sign of a cough. If DS gets to the wheeze, we're ER-bound.
I've used advair and needed several days to see improvement. IIRC, the allergist wanted to see DS after a week when he started it. He started with the disk several years ago . . . he was 8, I think. His doctor had him stop using it daily last year when it was clear his allergy shots are working. We start up again temporarily (along with xopenex) when he gets a virus if it involves a cough (which, for him, it always does).

[artvandalay]

Thanks for the update. From experience, I suspect you will see the onslaught of cold symptoms in the next couple of days. For some reason, coughers/asthmatics start with the coughing/wheezing a few days before a cold virus takes over. I have seen this again and again with myself and my kids, especially my oldest.

.

You were completely right, Kindra. Last night he became completely congested. This is the first time we've seen him with any cold symptoms since he started this severe cough last week. He is pretty miserable right now, between sniffing, coughing and sneezing.


Yes, this is what older DD has a well. She has allergy and cold/viral induced asthma.

Thank you guys for helping me put the pieces together. :thumbsup: I suspect this is what he has. He has never been diagnosed with this before. I have to call the allergist this morning to give him an update, so I will bring this up with him.

He also complained of his ear hurting a little last night. I think we may even end up in the urgent care clinic today so he can get his ears/lungs checked out.

Thanks again.

[artvandalay]

:yeahthat:
to both of these points. We treat at the first sign of a cough. If DS gets to the wheeze, we're ER-bound.
I've used advair and needed several days to see improvement. IIRC, the allergist wanted to see DS after a week when he started it. He started with the disk several years ago . . . he was 8, I think. His doctor had him stop using it daily last year when it was clear his allergy shots are working. We start up again temporarily (along with xopenex) when he gets a virus if it involves a cough (which, for him, it always does).

Interesting. Thank you. I won't be surprised if he needs to eventually get allergy shots. He still has the dark rings under his eyes and those small lines under his eyes, which the ped said makes him look like an "allergy kid". Glad your DS was able to stop using the Advair daily and just use as needed.

[noodle]

I hope your DS is feeling better soon.

We lucked out and found a great allergist/asthma doc who is also a pediatrician (but is only in an allergy/asthma practice) and an allergy/asthma researcher. Her goals for him were allergy and asthma control and as few meds as possible. That said, he's been on a lot of meds, but she stressed to us how important it is to keep him lungs from becoming damaged and causing future problems for him.

He started shots when he was 10. We see younger kids in there all the time, but he was not ready until then. He's pushing 13 now (how can that be?!) and spring is no longer scary. He can also be around cats and dogs now -- before he couldn't be around people who had cats and dogs (without even having the pets present) for long without reacting. Anyway, I ramble....

Viruses are still an issue. He's sick now and I got up in the night to dose him with xopenex (still my baby...). I don't like that he's sick, but I'm thankful to have a plan and meds that help him. Having a plan helps tremendously.

Best of luck to you and your DS. Asthma/allergies/breathing stuff is so stressful. :hug:

[artvandalay]

Thank you Jennifer. Sounds like you found a really great doctor. All of this is new to me, so I'm really learning as I go. Hopefully we will get things under control soon. Glad to know you and your son's doctor have found a good plan for keeping his asthma/allergies under control.

I hope your DS is feeling better!