Asthma meds and spacer for 3 yo??

[jgenie]

At DS2's 3 yo check up his ped mentioned changing him from a nebulizer to an inhaler and spacer combo. We ran out of meds for the nebulizer this week so I took DS2 in to get the new meds and spacer. I read all the included materials but I'm not sure we're doing this right. I can't see anything going into the spacer - is that right? I put the mask to DS2's face and let him breathe in and out with his face in the mask a few times - is that correct? We're leaving on a trip next week and I'm wondering if I should just get his ped to call in a RX for the meds we've been using and revisit the new method later. Thoughts? Also, if you're child is on asthma meds, do they see a specialist or does your ped manage everything? TIA

[khalloc]

Yes, you cannot see the medicine from the inhaler when it goes into the spacer. I let my DS breath in and out 6 times per puff on the inhaler.

My son has always just seen our pediatrician for his asthma needs. He was diagnosed at maybe 14 months and now he is about to turn 5.

[maydaymommy]

I put it on his face & put my other hand on the back of his head so the seal stays.

Press the inhaler & wait for 8 breaths.

My pediatrician sent us to allergist & asthma specialist and I'm more comfortable with that.

I just switched him from neb to inhaler.

[Kindra178]

Pediatricians can manage asthma but sometimes allergists and/or pulmononologists have more specific knowledge, willingness to try different drugs, etc (throw in an allergy drug to avoid further bronchial tube irritation). We see the allergist 1x or 2x a year but see the ped for run of mill wheezing caused by colds.

Research indicates that a spacer works as well as a nebulizer. For rescue meds when the child is actually sick and coughing or wheezing, we don't agree. Our doctor writes us scripts for both inhalers and inhaled solution for rescue meds. But for every day administration of preventative drugs, we use spacers. We have the kind with the mask that goes over the child's mouth and nose. We place the mask on them and count to 20. We use Flovent and have learned that you have to wash the child's face afterwards and rinse and spit/brush teeth. We do the former to avoid perioral dermititis from the steroid and the latter to prevent thrush.

You aren't going to see the medicine in the spacer. It used to be that inhalers had CFCs; it was much easier to see the meds. Think of the spacer like a bong. It holds the medicine until the child is ready to breathe it.

[Simon]

Yes, that is correct.
We've been using mask + chamber since Ds2 was 16 months. We meet with our pediatric pulmonologist and also an OT every 4-6 months who watches Ds2 and I do the meds (pretend) so she can evaluate our technique and correct our mistakes. She said the #1 mistake is releasing the medicine too soon, before the mask is in place. So, you may already know these, but I'll just review the basics.
Shake the inhaler first. This is important to mix the med w/the propellant chemicals.
Be sure there is a good seal around his mouth, nose, face before you release the medicine.
We also do 6 breaths per puff.
If you are using a rescue medicine (ie. albuterol, combivent) plus a steroid, be sure to do the rescue inhaler first. Then wait 5-15 minutes to allow it to work and then do the steroid.
Be sure to wipe his face/rinse his mouth out after. We usually have Ds2 drink some water. The steroid makes them more vulnerable to thrush infections. BTDT.

If your mask is like ours, there is a little valve that goes back and forth as the child breathes. We count the valve movements as breaths. This also tells you that you have a good seal. Sometimes I tell Ds to breathe like he's going to cough so that he takes a very deep breath.

Also, FWIW, if you are used to a nebulizer as rescue medicine, keep in mind that it delivers something like the equivalent of 15-20 puffs (depending on med, etc.; that is the estimate they gave us for albuterol).

Personally, my feelings about pediatrician management vs. specialist management depend on how severe the asthma is and how comfortable you feel with your current plan. Ds2 has asthma that is not severe (we don't end up in the ER) but is very difficult to manage (ie. keep controlled so he isn't having minor trouble all the time). For us, I do think its key to have a pulmonologist on board, although we usually meet with her NP. But, this NP only works with asthma/CF patients so its her specialty. She really knows her stuff and the pulmonologist is always available for a consult.

Do you have an Asthma Action Plan? It details when and how you add in rescue meds, and bump up to needing oral steroids/additional intervention. How often does your Dc need the rescue inhaler? If I were using a rescue inhaler more than once a month AND if my ped. didn't provide us with an AAP , I'd be very uncomfortable unless the asthma is very minor. IIWY, I might just go for a consultation and then see if I felt a need to make a permanent switch.

[Fairy]

Kicking in here briefly, DS is 8 and has been going to a pulmonologist since he was 5. If it's very severe, I'd go now to a pulmo. If it's mild to moderate, then if your ped knows what s/he's doing there, stay there.

The spacer is definitely like a bong, we think of it that way, too. Only DS doens't take in and out breaths, and we do't use a mask. He puts his mouth around the round end, then I suqeeze the pump, then he inhales deeply and sharply and holds it in his lungs for a count of 10, then exhales. Then we do it again. That's for the Advair.

If DS needs Albu, then we always use a neb, he only does the inhaler of albu at school. I really think the neb is the right way if rescue meds are being used (rather than maintenance).

[PZMommy]

My son is only 18 months old. His asthma is severe due being a preemie and getting rsv when he was a few weeks old. His pedi sees him for day to day stuff, but he was referred to a pulmonalogist at a children's hospital. He sees him every few months.

[khalloc]

I wanted to add that my son only has cold-induced asthma. He only has trouble when he is sick with a cold and its not all the time. He seems to be growing out of it and his asthma is well controlled with Flovent. So we stick with the pediatrician, although I think she specializes in asthma as well. So asthma might just be her thing. I am perfectly happy going to our regular pediatrician for any asthma troubles he might have, especially since his is pretty mild.