Monday, October 24, 2005

#2 Goes to the Pulmonologist; #1 Starts Coughing Again.

As mentioned, took #2 son to the peds. pulmonologist today. He was diagnosed with mild Reactive Airways Disease. No big surprise there!

She gave us an action plan and recommended daily Pulmicort. I opted to hold off for a bit...I don't think we really need it yet. But we've got RXs for albuterol & Xopenex, and she gave us spacers and neb stuff for now, until the cough clears up. (It's much looser and better now.)

We had a chest Xray, too...but we haven't gotten the results yet. I suspect they're clear - although I wouldn't have said that a few days ago.

I just realized that she didn't take his sats. Wonder why...?

I'm so relieved that we have that diagnosis now. It's comforting to know we can page the PP if he ever has a cough like that again! Just having an action plan is comforting. When you have a sick kid, nothing feels better than knowing you're able to give them the care they need. It's all you want, as a parent.

On the other hand, #1 son was coughing again this morning. Nothing new there...same old junky cough we hear three times in the morning and twice at night.

Only we heard it about 10 times tonight. And he was sniffling today. And he was coughing REALLY hard at bedtime.

I gave him Dimetapp and albuterol before bed, and that seems to have helped.

I only pray that we'll get a break this time....! I don't want him to be sick again. And I don't want to have get up three times a night to neb, either!!

How #2 Son Got a Reactive Airway Disease Diagnosis

So...#2 son was diagnosed with Reactive Airway Disease today. (You'd think I would've remembered to ask for an info sheet so I could've gotten a proper definition, after my last post!)

Just to document how this came about, here are some snippets from emails I sent to the asthma parents' list over the last week or two:

From 10/14: Oz is still coughing. Let's just hope they don't decide to share illnesses. As they do share a room, there's little I can do to prevent it, but really -- let's hope!!!

From 10/17: BOTH boys are coughing now, and #1's cough has picked up a little punch. I'm still going with the albuterol 3-4X a day. He didn't cough much (if at all) overnight, but definitely started up again this morning. The fever had broken by Sunday AM, and he hasn't thrown up since Friday.

Oz's cough is getting worse (louder, more frequent, still wet), so I need to check my notes to see when that started. Since I had him at the doctor last Weds., I'm guessing it's been about 10 days since the cough started, maybe longer. Mucus is yellowish now, but it was clear for the first week or so. Could be a sinus infection, but I've never seen one start with a cough. Don't know...

From 10/19: Oz is doing much better with the pinkeye, but he was coughing a LOT last night. I gave him some Dimetapp, which dried the cough up but didn't stop it. Even though he's not officially RAD, the doc said I can give him a neb of Xopenex if he has another night like that.

From 10/20: Had a REALLY bad night with Oz, not #1. Gave him Dimetapp at 8:00pm, but ended up needing two nebs at 11:00 and 4:30 as tight coughing would not stop. Could be bronchiolitis. Have a call into the ped's office (he's not with a PP - yet!) to see about a Zithro RX, or another appt.

From 10/21: Now, about the kids -- Oz is a MESS. He's so much worse today. We were up three times over night. He's responding well to Xopenex, but he's running 101.5 right now. He sounds terrible (need to neb him now, actually) and he's not drinking well. He was coughing his head off overnight when the nebs wore off.

Took him to the ped today, who changed his RX to Zithromax (thank you!) for a sinus infection. She said he may have RAD, but said she didn't hear any wheezing, that his lungs sounded clear. But she said I should call our PP, given his history, and see if she wants to start seeing him.

So I did. And we're going Monday.

Honestly, I think he has RSV, and I'll be amazed if we're not at the ER over the weekend. But I'm a freak, could be wrong. If he doesn't respond to the Zithro and he's still sick on Monday, $100 says that the PP here's something and that his sats are around 95%.

Ugh. Thank goodness he's happy. He sounds so, so awful, it makes me want to cry

Later that night: Ugh. Oz woke up from his nap with 101.5 and sounding SO MUCH WORSE. Sounds really chesty now. I nebbed at 4:00, which helped. By 7:00, as we were finishing dinner, he was coughing til he gagged. Almost paged the peds., but held off.

Nebbed at 8:00, and gave him Dimetapp. Definitely took the edge off the cough. He went right to bed afterwards.

It's 9:30 and he's just starting to cough again. I have a feeling he won't last beyond 11:00, and I'll have to page to make sure he can have his nebs 3 hours apart instead of 4.

I'll be amazed if we get through this weekend without a trip to the ER.

From 10/22: Miraculously, not much coughing overnight and very little this morning. He's definitely not himself, though. Yesterday, when he was coughing his little head off, he was still acting like a happy little toddler. Today, he's much quieter, not eating or drinking. Also more visibly congested.

LATER....Zithro is for a sinus infection, which I'm not convinced he has.

He was doing surprisingly well all day, then we noticed he was breathing really fast at dinner. I was going to neb him, but I noticed he felt really warm. Turns out his fever spiked back up to 102.1, after being 99.5 earlier. Ugh. He fell asleep, and I'm going to check his resps in a little while. (I managed to get some Motrin into him.)

October is sucking, so far.

Saturday, October 22, 2005

Bird Flu Update, Roche & Tamiflu and More in "Weekly Breather"

Asthma parents, if you're not getting the American Lung Association's 'Weekly Breather,' you're missing out on a valid resource. This is by far the best, most reliable means of getting helpful asthma news.

Here are a few highlights from this week's issue:

WHO: Bird Flu Human Risk Greatest in Asia...An October 17, 2005 Associated Press report said cases of bird flu can be expected to appear in many countries, but Asia is most at risk. According the the World Health Organization, avian flu has become endemic in some areas of Asia, creating multiple opportunities for a mutation to occur that would result in the virus’ ability to spread among humans. This weekend, tests on birds from Romania indicated that bird flu had arrived in Europe. Two days earlier, cases had been confirmed in Turkey. However, the vast majority of cases, and the greatest risk of viral mutation, remain in Asia. Bird flu has killed more than 60 people in Southeast Asia in the last two years. Most cases have resulted from contact with infected birds, but experts fear a genetic mutation could produce a global pandemic.

For the full article: click here.

Roche may allow others to make Tamiflu...Reuters reported in an October 18, 2005 article that on Tuesday Swiss drug maker Roche said it would consider granting other firms licenses to make the antiviral drug, Tamiflu. The company is under pressure to step up production of Tamiflu as cases of bird flu have appeared in Europe. Tamiflu, known generically as oseltamivir, is the most effective antiviral drug currently available for avian flu and is one of a class of treatments recommended by the World Health Organization (WHO) for use in the event of a flu pandemic. Mike Ryan of WHO said Tamiflu supplies were insufficient if the avian virus were to mutate and spread among humans. Roche said it would consider allowing companies and governments in developing nations to produce the drug in preparation for a bird flu pandemic. Governments are rushing to build stocks of Tamiflu; 40 countries have placed bulk orders with Roche, including Turkey where cases of bird flu were reported last week.

For the full article: click here.

...and there's so much more, just in that issue. To sign up yourself, click here.

Normal Respiratory Rates in Children vs. Tachypnea

This came up on the asthma-parents list. #2 son was going haywire yesterday, coughing until he gagged. (He's going to the pulmonologist for the first time Monday.) More on that later...

Anyway, I was completely freaking out, so I checked his resp rate about a dozen times overnight. But I don't know what the normal resp rate is for an 18-month-old. (Obviously, if he was at 50-60 breaths per minute, I would have rushed him to the ER.) So I sent an email to the other asthma moms....and they didn't exactly know either.

So, in typical "Angry Asthma Mama" fashion, I hit the search engines. Here's what I found, per my email to the moms:

"Tachypnea was defined as a respiratory rate >60 breaths/minute in children 2 >50 breaths/minute in children 2 to 12 months of age, and >40 breaths/minute in children =" border=0>1 year of age."

According to this article, presence of fever raised the rate by 10 breaths per minute. The article's actually pretty interesting if anyone wants to read the whole thing -- it's about using resp. rate to diagnose pneumonia. Here's a link: Tachypnea is a useful predictor of pneumonia in children with acute respiratory infection.

That article led me to this one, which has a fuller age range:

"The World Health Organization's age-specific criteria for tachypnea are the most widely used: a respiratory rate of more than 50 breaths per minute in infants two to 12 months of age; more than 40 breaths per minute in children one to five years of age; and more than 30 breaths per minute in children older than five years. (14)"

And yes, the context was diagnosing pneumonia.

Hope someone else finds this useful!

Friday, October 21, 2005

Reactive Airway vs. Asthma

Those of you who've been reading this blog for any length of time know that I think the diagnosis of "Reactive Airways Disease" is a load of bologna with a capital "BS."

Well, on the asthma parents list, the topic came up, so I thought I'd delve into a bit in the place where I can be as opinionated as I like. (So glad blogs were invented!) Here's my little rant, followed by some legit info:

The way I see it, it's either asthma, or it's not. Nothing pissed me off more than the doctor at some practice or other who once corrected me when I referred to little B as being asthmatic. "He has Reactive Airways," she said. No, you stupid cow. He has asthma. Any kid who's on Flovent 220 and Singulair year-round, has been on Orapred more than half a dozen times before his third birthday, sees a Pediatric Pulmonologist on a regular basis, and has spent more time in the ER than both his parents put together deserves to be properly diagnosed. Don't use your stupid, namby-pamby, politically and legally safe terms to describe MY kid's asthma.

And while you're at it, give us parents some credit. We're very much in control of our son's health, and I think we know what we're dealing with.

Okay. Off the soapbox..

Here's the stuff I found about "Reactive Airway Dysfunction" (or "Disease," depending on your source):

From eMedicine:

Background: Not all children who wheeze have asthma. Most children younger than
3 years who wheeze are not predisposed to asthma. Only 30% of infants who wheeze go on to develop asthma. Reactive airway disease has a large differential diagnosis and must not be confused with asthma.

Clinical factors suggestive of childhood asthma include recurrent wheezing, symptomatic improvement with a bronchodilator, recurrent cough, exclusion of alternative diagnoses, and suggestive peak flow findings...
(Hmm...How are they getting peak flow readings from kids under the age of 3??)

Here's an interesting paper on RAD and Irritant-induced asthma (IIA) by Thomas H. Milby, MD. Just one interesting snippet:

Once symptoms do become clinically apparent, both RADS and IIA behave clinically
like non-allergic asthma, which, of course is what they are.


Interestingly, this paper mentions nothing about RAD as a "pre-asthma."The author describes it more as a reaction of the respiratory system to an external substance, like a toxic gas or something. And the difference between RADS and IIA is the period of time before the reaction occurs. To me, this sounds like the most appropriate definition of the term "Reactive Airway." Read the article. See what you think. (This article also backs up the definition.)

Hmmm. Hold the phone. These are describing "Reactive Airway Dysfunction Syndrome." Is that different than "Reactive Airway Disease?" Must research. Must learn.


Ugh...I've spent over an hour looking for definitions for both, and I haven't found a THING. I suspect they are different. I'll keep looking and post more tomorrow.

Wednesday, October 19, 2005

"Coughing Syndrome"

Well, I talked to the nurse-practioner at our pulmonologist's office today, and she said there is a "syndrome" going around. Kids are hacking like mad for two weeks. Seems to be viral. They're treating a lot of their patients for this now, most of them NOT responding to albuterol.

She said if #1 son had a bad night tonight that I should call tomorrow and they'll slot him on Friday.

He's not coughing that much, although it sounds bad when he does. Really, just before bed and in the morning, and he is responding to albuterol. He looks better today, too. I'm not anticipating a bad night with him. (Famous last words, right?)

#2 son is doing much better with the pinkeye (I've posted about that, right?), but he was coughing a LOT last night. I gave him some Dimetapp, which dried the cough up but didn't stop it. Even though he's not officially RAD, the doc said I can give him a neb of Xopenex if he has another night like that.

**Confession: I could/should have given it to him last night, but I was so freaking tired that I just didn't. I'm a terrible mother. I PROMISE to do it tonight if he's coughing!

The news from the PP's office has me holding off on Omnicef, anyway, which the pediatrician wrote an RX for the other day, just in case. He'd been coughing for almost 10 days, maybe more, when we went in for the pinkeye on Monday.

I'm also wondering now if I shouldn't have the PP see #2 son. There've been so many times the ped has seen #1 and said his lungs were clear -- then next thing I know the PP has me taking him for a chest X-ray because he's "not moving air." I've learned that peds. asthma is so subtle sometimes, regular peds. who aren't specially trained miss the wheezing or lack or movement.

Of course, I could just be amazingly paranoid. There's always that possibility, right?

Tuesday, October 18, 2005

Started albuterol

The cough's tightened up over the last day or so, even though I started albuterol on Sunday. We'll see where it goes from here... (This is #1 son)

The baby has conjunctivitis and, possibly, a sinus infection. He's been coughing for 10 days or so. I just wonder if it isn't viral, and that's what #1 son has. I'll give it another day before starting antibiotics.

Ah, the trials of motherhood.

Saturday, October 15, 2005

Stomach Virus Triggering Attack???

The morning after I'm told to take it easy by my midwife (I have an infection that put me at risk for preterm labor), #1 son wakes up with a fever. I saw this coming, as his coloring's been off for days and he had a cankar sore -- which always means something's coming.

I thought he just had a stomach virus. He was complaining that his tummy hurt (which can also mean his chest hurts, you never know) and had no interest in eating. He did have half a Dunkin Donuts pumpkin muffin and some soy milk mid-morning, but after napping for a bit, he brought it all back up. (So much for my resting -- I had to clean the sofa and the boy!) But I figured that was it. I just tried to get him to drink small sips of water or Pedialyte for the rest of the day.

This morning, he woke up still looking feverish and puffy. He hadn't thrown up again, but he was still nervous about eating, and he was really lethargic. He napped for a few hours, and then seemed much better.

Except that he was coughing!

It wasn't the typical, tight asthma cough. It was loose and junky, and completely lacking in punch. (I equate his "regular" asthma cough to a snare drum.)

After hearing these messy sounding coughs for much of the morning, I gave him some albuterol this afternoon. I didn't really think it was asthma related, but two puffs of albuterol...better safe than sorry.

Guess what? The coughing stopped.

I don't know if that's good or bad. On the one hand, I'm glad he's not coughing. On the other hand -- that junky cough responded to asthma meds. I can see how any cough might respond to albuterol via nebulizer; that's like standing in a room with a steaming shower. But this was via MDI. Does that automatically mean the cough is asthma- related? Or does any cough respond to albuterol, even administered through a spacer?

I guess we'll see. I'll post an update tomorrow.

BTW -- if I haven't posted as frequently, it's because I've become really involved the Asthma Parents mailing list through Yahoo! groups. I highly recommend this group; they're a great bunch of knowledgeable, supportive women.