Saturday, December 27, 2008

Tracy's Question: When the Asthma Action Plan Needs Revision

Tracy posted this question to a post, and I thought it was worth adressing front and center:

"I am new, but desperate to find some advice. My 4 year old has asthma and has been on albuterol, pulmicort, singulair, and prednisone for a few years on and off. His 6 year old sister brought a cough/cold home from school last week and now he is battling it. All of the parents of asthma children know that when they get a cold/'s SOO much worse for them over other children. I'm at my wits end, he is coughing and coughing for days now. The doctor told me to do the regular routine...albuterol/pulmicort in his machine. It doesn't seem to be helping, he has made himself vomit 2 times from his coughing attacks. It's now Saturday night, 6:30 pm and he's coughing nonstop. He isn't wheezing, but his breathing is fast. The cough is the worst, and I don't seem to be getting much help from his doctor.

Any advice on how to help the cough even a little bit other than his albuterol/ pulmicort/ prednisone. I feel like I'm overmedicating him today. I'm so stressed, he can't stop coughing. I'm not sure if it's time for a trip to the ER, but not sure what else they can do for him, we have all the meds right here, it just doesn't seem to be helping. "

I don't know if it's documented anywhere, but I swear some kids develop a resistance to albuterol.

So here are my questions for Tracy, right off the bat: Are you seeing a regular pediatrician, or do you see a pediatric pulmonologist or asthma/allergy specialist? If you read this blog regularly (and considering you came in via a post from 2005, I'm guessing you might!) you know how important I believe this is: Pediatric pulmonologist just "get" pediatric asthma better than pediatricians do. We have seen our pediatrician and been told our child was "moving air well," then seen the PP a few hours later - only to be promptly sent for a chest x-ray!

Question 2 for Tracy: When did you last have your action plan updated? It may be that your son has outgrown his current dosages, or needs stronger meds. Our middle guy is fine on Flovent 44 for the summer, but needs to be on Flovent 110 this time of year. Last year, we bumped him to the 220 for the winter months.

When it comes to the emergency meds, I always have albuterol and Xopenex stockpiled, but have found that when things get really dire, we need DuoNeb and Combivent, as well, which are stronger. (I don't know if they're typically prescribed for kids, as they seem to be COPD meds, but they definitely take care of those evil coughing fits.)

I've also been lucky enough to have a great PP with a great staff. They know I've learned to treat mountains as mountains and molehills as molehills (it took a few years...), so they've empowered me to take certain measures at home. If things are really bad, I'm allowed to administer three doses of albuterol 30 minutes apart. If there's no relief from that, we either go straight into the office, or straight to the emergency room. Note - DO NOT do this without the permission of your own doctor. I will only take these measures after calling the office and checking in first!

One more trick we keep up our sleeve: Dimetapp. If your doctor allows it, we find that this alleviates coughing caused by upper respiratory symptoms. It's not a cough supressant, so it's OK for asthmatic kids to take. Bonus: Helps them sleep, too!

So, Tracy, I hope this is helpful. I'm frequently in your shoes, and I know what you're going through. Of my three boys, Oz, my 4 YO, is currently the worst asthmatic. He will cough until he gags. Sometimes, he can't get through a sentence without coughing. It's awful, and I will do whatever I can to make it stop.

We've had a good winter so far, but he has started coughing today - and I'm visiting my in-laws in Canada without the nebulizer, so I hope I didn't just jinx myself.

Please feel free to respond via comments or email.

1 comment:

Jamie said...

I wanted to share a quick story....I have a friend of mine with a child that has a degenerative brain deseise - She does not have asthama per say HOWEVER she has some major breathing difficulties and it causes her to throw up daily and not be able to sleep through the night. She tried an air purifier that made a HUGE HUGE difference! Feel free to look at the website to get more info. It is not a medical device BUT she saw MAJOR results - the throwing up stopped, the coughing stopped and she is sleeping through the night! The best thing she told me was that she was able to try the product for 7 days before making a decision. The child's teacher even commented on her breathing while she was at school! Pretty kewl!