Tuesday, March 04, 2008

Pulmicort 'Roid Rage - response to question in comments

This came in today via comments:

I'm not sure I'm typing in the correct spot... I'm new at this. I was hoping to find some answers to a question I had concerning my son. I was wondering if you have heard of any children becoming aggressive or violent from the medicine Pulmicort? My son just turned 3 and since on Pulmicort has been exhibiting some very violent behaviors. Maybe just hit at the same time???? who knows? Do you have any advice or help?

I've been fortunate to have never experienced this, but I've definitely heard about it before.

Pulmicort is a steroid, and sometimes kids will react to it the same way grownups react to, say, anabolic steroids.

While some parents are OK if their kids "occasionally kick the dog," as one mom so quaintly put it, so long as they can breathe, sometimes the behaviors are a lot more extreme and hard to live with.

I've heard, on the Asthma-Parents Yahoo group, that other parents have seen better results simply by switching steroids. So ask your doctor if Flovent or Qvar is an option for child. Ad there's an added bonus: Being a "Flovent Mom" myself, I can assure you that administering a metered-dose inhaler (or MDI) twice a day is a LOT easier than holding a three-year-old down for a nebulizer treatment every single day.

Singular is another commonly-used maintenance med for preschoolers. I've rarely heard of adverse reactions from it, but it does work differently than inhaled corticosteroids like Pulmicort and Flovent, so it may not be right for your son's needs. In fact, my kids have needed to be on both Flovent AND Singular during peak season.

So...I hope this helps. Definitely talk to your doctor about alternatives. You shouldn't have to live with a psychotic preschooler when there are other options available.

Other parents, please feel free to share your experiences and wisdom!


blacktietrio said...

My son is 7, and autistic. He has had mild reactive asthma since he was young. All of his former doctors chose to not put him on the daily inhaled steroids. One doctor had him use Singulair during the allergy season (October - March or April).. Now we have a new doctor who is insisting that he go on Flovent for asthma control. I really don't want to jump right for the big guns. I am planning to have a consultation with him to ask him about trying Singulair first. I am afraid of the aggression and dependence on the steroids. I saw it happen in my husband who began with just seasonal and reactive mild asthma and now needs Advair year round and Lexapro to bring him down from what I am sure is 'roid rage- My husband when he first started taking the steroids became very unreasonable and overreactive to everything. When he skips his Lexapro, I can tell within a day.
I read recently, that lately the pediatric approach may be to go for the strong meds at first to get it under control, then try to step down from there. Though my doctor did not mention that this would be the strategy. It seems that is what happened with one of your sons, Aimee. I have been feeling like I need to try to get them to try to control his mild asthma without these. If for anything- just to save it for when the situation requires it.

Aimee said...

Hi and thanks for commenting! I'll address more of this later...but here's my take on aggressive treatment:

Yes, our PP does treat peds asthma aggressively. I believe the philosphy is that the more aggressively it's treated at a younger age, the faster they'll "grow out of it" or be strong enough to control their asthma with mininal meds.

As far as steroids, as I've said, we never saw any aggression. The only side effect we could definitely attribute to the Flovent was my oldest sons perioral dermatitis, or "steroid acne" when he got off the stuff.

What I can tell you is that Flovent kept us out of the emergency room time and time again. It made subsequent cases of RSV and the flu manageable and hospital-free.

It ain't the nicest stuff in the world, but for us, it WORKED. My oldest has been off the 'roids for a year, and he's doing really, really well.

If you believe your child is susceptible to aggression, then - by all means - share your concerns with your PP and explore other options. There are other maintenance meds out there, and a good doctor will respect your concerns.

Good luck, and thanks again for the comment!

On another note -- would love to compare notes on autism-related therapies. I'm currently trying to track down a good psychologist, if you've got any pointers.

Momma Bean said...

Hi there! I just found you when I googled "toddler asthma cold"! My little 2.5 year old was diagnosed with asthma at about 18 months. She has had wheezing/labored breathing since she was born, but the specialist was hesitant to actually label her as asthmatic at such a young age. It didn't help that everytime I brought her in, she was too busy crying to display her normal breathing patterns. You'd have thought I was nuts when I practically jumped for joy when he finally heard the wheezing!

Anyway, Audrey was on Singular granules for about three weeks and it was torturous. She had night terrors, which I didn't recognize at first. The doctor did mention that she might initially have trouble sleeping, but I was totally unprepared for the frightened shrieking in the middle of the night or the various attempts by her to stay awake and her growing fear of her nursery! Needless to say, I made him switch medications and he moved us to Pulmicort respules. She takes one twice a day and I don't see much, if any, aggression. She's a bit more intense than her twin sister, but I think that's partly personality. Once in awhile, she'll pop her sister in the arm, or scratch her, but then Maggie will do the same thing - so I chalk it up to age.

Her breathing is better and the wheezing has subsided with the medication, but when we tried to go down to 1 treatment a day last fall, it didn't work. Every now and then, we'll hear her labored breathing. It's usually when she overexerts herself. But the increase in activity and her ability to keep up with her sister since we started the Pulmicort makes me assume that this mediction is doing something right.

Anyway, it was good to find you! I'm off to read some more.

blacktietrio said...

Hi! Sorry it took so long to get back. We did start my son on Flovent. The wheezing attacks at night requiring albuterol stopped within a day or so. So it does what it is supposed to do. We don't always give it twice a day. His behavior seems OK. However, his rash around his eyes has returned. It happened last time we started FLovent. His eyes are also very puffy. It got so bad last time that the doctor thought it was MRSA.
We asked if it might be related to the Flovent, but he said no. However, one of the side effects I read was a rash. It started with dry flaky skin, which he rubs until it is raw. The Dr. recommended Aquaphor or Vaseline. The Aquaphor seemed to do nothing but make his eyelids greasy. I used the lip therapy Vaseline (as the texture doesn't seem as heavy and greasy) The texture of his skin around the rash seems to be getting more normal, and the raw spots seem to be healing better.
What kind of therapy were you thinking about? My older son gets counseling. He is 9. We think he has Asperger's, but it is hard to get a diagnosis. He definitely has social and anxiety issues, as well as being overly-sensitive to noise.
He dialogs movies and TV shows constantly when alone in his room.
He has poor writing and coordination skills. We would like him to get PT. Right now all he is getting is OT. He started speech therapy, but the therapist quit and now he is on waiting list. MOre for better processing and communication skills.

Aimee said...

Hey, BTT - For your 9-year-old...have you seen a developmental pediatrician? We're so lucky to live within 10 miles of two top hospitals, so we see a deve ped at the one we prefer. She actually provided the diagnosis -- but it was the school district that referred us to her! B was admitted to a preschool disabled program, and they sent us for the developmental evaluation.

We just had him re-evaluated, and he was off the charts for "atypicality" (we were NOT surprised. No one can know or care that much about Pokemon and Transformers and be "typical." And he *is* my son!!!) but he was borderline for hyperactivity (that WAS a surprise) an depression. That's why we're going for therapy.

We're in a great school district, so he actually gets PT, OT and social skills at school. And we have him swimming lessons and special Tae Kwon Do class to support the therapies, as well.

Good luck getting a DX - it definitely helps. We wouldn't get all those therapies through school without it.

MOMMA BEAN - your comment was a revelation. B used to have night terrors frequently, and we never associated it with the Singular! He's been on it since age 2. We took him for multiple sleep studies, and we never suspected...
Thanks for that!

For us, though, Singular was the "silver bullet." It wasn't until we added it to our arsenal of meds that we finally got B under control.

It would have been nice to know about the night terrors, though!!!

Anonymous said...

Hi, my 4 year old son is asthmatic and developed bad acne (he looks like a teen ager with angry red rashes on his face)... after seeing the allergist, two pediatricians, and three dermatologists, none of which could figure out why he had acne I finally read about steroid acne in AN AIRPLANE MAGAZINE....Blame it on the pulmicort...which also makes him go hyper crazy...

He has been on antibiotics for the acne for nearly 6 mo now and it is slow going...

From a VERY angry asthma mama..

Anne Marie said...

Hi! I'm new at this. Neither myself or my husband have allergies so we're a bit overwhelmed. Our 5 year old daughter started having problems with seasonal allergies a year ago. It started with a dry cough, almost like she was clearing her throat. Our pediatrician tried a number of different meds.....cough suppresants, pulmicort, albuterol, singulair, zyrtec etc. We were having horrible behavioral problems with her and were trying to figure out what the culprit was. Fast forward a few months and she came down with pneumonia so she was put on the usual breathing treatments as well as oral steroids.....again....horrible! She did get better and we were able to wean her off of all of the meds and added Flovent 2x/day. We went to an allergist the following month. He thinks she may have allergy-induced asthma (she hasn't been able to do the asthma test yet) and recommended we keep her on flovent 2X per day, add singulair and zyrtec as needed. The spring went well until she started having A LOT of night terrors. After doing some research, I realized that singulair may have been the problem. She was doing so well over the summer, so the allergist took her off the singulair to alleviate the night terrors. It seemed to help and the night terrors have decreased significantly, but she still has them from time to time. In the last few weeks, her coughing has picked up a lot, but I feel so reluctant to put her on any more meds. I'm also wondering if Flovent is causing night terrors as well. I am just so frustrated with all the allergy meds....she has had such awful reactions. Obviously everyone is different, but have any of you had positive experiences with allergy meds? Any meds I may want to suggest to the allergist? Any input is appreciated!

Walter said...

Hi. I have dealt with many allergy and breathing-related problems with my children. We realized that cow's milk was a huge contributor to the breathing troubles.
The last bout that took us to the ER with pediatrician follow-up a few days later. I was recommended, by the ped, to put our child on pulmicort, continue the albuterol, added singulair instead of the zyrtec and then added an additional liquid steroid to speed things up. This is for a 21 month old child. I took it upon myself to NOT give him any of it except the Zyrtec he's used before and the albuterol he's been using. I then asked people to pray for him and we prayed for him.
I had a re-check on Monday in which the doctor said he sounded fine and reveled in her diagnosis and medication cocktail.
I did not tell her that I did not give him all those things.
Granted if he had worsened I would of used ONE of the options. I definitely would NOT use the singulair. The bottle is labeled with the warning of nightmares and adverse behavior.
The allergy scratch test is a good tool to determine the exact cause of an allergic reaction, but you never know what is going to trigger the breathing problems.
You can keep a food journal for the child and do not wear cologne/perfume. Use unscented everything--detergents, fabric softners, shampoos, body soaps. One of the worst culprits are room deodorizers--sprays, candles and especially those things that plug into the wall.
To benefit you and your child stop using anything that has a scent.
BTW pulmonary specialists concur with erratic behavior brought on by breathing treatments. Hope everyone is breathing well!