Asthma in Children and the Fear of Pulmicort

New Question - Just In:

HELP!!!!! My son is 7, was dx w/ asthma this past winter after a lifetime of treating what different ped's "thought" were simply nasal infections with antibiotics. We have recently went from zyrtec, to oral steroids, now on to pulmicort, albuterol and Singulair. I am VERY afraid as my son is already a sensitive and emotional boy. It sounds like the pulmicort is simply a BAD med??? Does anyone have any homeopathic advice on treating asthma? My mom is permanently disabled from medications that were not properly tested and monitored...I am in search of help, not more hurt!!! - Tammy

Tammy, I'm *not* a doctor, but I have a few insights I can share from experience:

First of all, many of us who have used Pulmicort and Flovent (same med essentially, delivered differently) have found that Flovent may tend to have less "roid rage"-type side effects.

Personally - and I do have sensitive boys - I haven't seen any negative behavioral effects from the steroids. (At least not that I remember!) Certainly albuterol has them bouncing off the walls, but I give Xopenex as often as I can to aovid that.

I can tell you that it works - WELL. For children with asthma acute enough to require daily inhaled steroids, there aren't many alternatives. None of us likes the fact that our kids are taking steroids every day, but it certainly beats the alternative of not being able to breathe!!

The best recommendation I can give you, though, is SEE A SPECIALIST. If you've read this blog at all, you'll know that I love my pediatricians. But when it comes to asthma-related issues, I call the pulmonologist first, then make a courtesy call to the regular peds to keep them in the loop. Pediatric pulmonologists know more about asthma than general pediatricians do, and understand the subtleties, the latest meds, and so much more than any other doctor.

If there are no pediatric pulmos in your area, look for an allergy and asthma specialist.

On the holistic side, I know many parents who have seen benefit from taking their kids off dairy. Others have seen a lot of success with sinus washes (now sold as "netti pots" at your local CVS) particularly if their kids' asthma is typically triggered by upper respiratory infections.

Again, I'm not a doctor or medical professional of any kind, but this is my best mom-to-mom advice.

I would also refer you to the Asthma-Parents group on Yahoo, which has been a great resource for me over the years. Two other sites:

• http://www.breatherville.org/ - the site of Mothers of Asthmatics, which also provides discounts on nebulizers and other equipment, among many other resources; and
• http://www.lungusa.org/ - the American Lung Association, which has great newsletters.

Hope this is helpful. Best of luck, Tammy!

Speaking of working mothers' guilt...Daycare Drama

I'm switching the little boys' daycare this week. The one they've been in was B's third, but he's in 1st grade now -- and this is the only daycare the two little guys have ever known. So you can imagine how grueling a decision this has been.

The place was really nice for the first few months we were there. I should have known, when the director who showed me the place departed on our first day there, (departed *for good*, I should add) that the outlook might not have been good. And now, four directors later, I can say that it was, at times, very good. But right now, it sucks.

After the last director left, the new one, Miss R. came in very quickly. Rob and I call her "Miss America" because she literally comes to work with pageant hair and full makeup - including eyelashes. She's built like a beauty queen, too, and loves to wear tasteful, expensive-looking, very fitted clothing to show it off.

Miss R looks very professional, but she - like the rest of the staff - is very young, with no children of her own. She's concerned with things like ratios, and classroom supplies. She loves the cute kids, but hasn't an inkling what it's like to leave your children with strangers every day.

So, needless to say, she's part of the problem. She hires young staff, doesn't announce when they leave, doesn't announce when new staff joins, and doesn't communicate well with parents. When I talk to her about concerns I have, I often feel like there's a language barrier or something. I can practically see everything I say fly right over her perfectly styled head.

Turnover is a problem, too. Half the time, someone I've never met is handing my kids to me at the end of the day. There's only one teacher who's been there as long as we have.

That's the background. Here are the actuals:

1. Frequently, when I drop Ig off, his room is over ratio. Now, if this place didn't already push state limits, it probably wouldn't be such a big deal. But on a GOOD day, there are two very young women with 14 2.5 year old. I can barely manage 1 two-year old. But seven? So if there are 16 kids in there, I will wait until kids and teachers are shuffled appropriately and I can feel safe leaving my son. The waiting makes Ig uneasy and me late for work. And it's an ongoing issue.

2. When I pick up, the boys will sometimes be together in one room, with a teacher I barely know watching tiny little Ig with a bunch of older 4YOs. Which wouldn't be so bad if the teacher was actually watching and if Ig weren't so tiny and immature for his age.

3. On 3 separate occasions, Ig has come home with no pullup and no undies. Funny the first time, downright concerning by the third. He doesn't have tear-away pullup. He has to take offf his pants and undies to do this. Which means he's got to be alone in the bathroom for close to five minutes to accomplish this task. And did I mention that he slipped in the bathroom and had to get stitches a few months ago?

4. Ozzy had an asthma flare last week. I would have kept him home if I had any flexibility at work, but I coudln't. So I nebbed him up and sent him to daycare with an alubterol MDI. I filled out all the forms for him to get the meds....and he didn't. They forgot to give him his 4 o'clock dose. They. Forgot. To. Give. Him. Asthma. Meds.

...and that was the final straw.

So I'm moving them away from their friends to a nearby center. The new place is about half the size and family-owned. It's clean. And Ig's room has 8 boys and two *mature* caregivers. Ozzy's room has three teachers; one of them is the owner.

I feel good about the move, but it's a LOT more money...at a time when no one has a LOT more money for everything. And it's disruptive to all of us.

I wish this wasn't a necessary step, but I don't think our current childcare situation is repairable. Miss America takes responsibilty for nothing. She blamed Ig for the diaper removal. While her business manager admitted to forgetting Ozzy's medicine, she lied to corporate -- and essentially blamed Ozzy for lying about the missed dosed! She blamed the teachers for Ig's stitches and the business manager for the ratio issues. I can't work with someone who can't own their mistakes. Doesn't she realize that her staff is reflection of herself? That if she were on "The Apprentice," the Donald would have sacked her ass?

Hopefully, the kids and I will be happier at the new center. Ig's been very clingy at drop-off lately - a new behavior for him, probably sympomatic of the chaos he has to deal with once I leave.

As my co-worker so aptly put it, "It's OK to *miss* your kids while you're at work, but you can't *worry* about them."

Ain't it the truth?

Working Mothers of Asthmatic Children - Time to Lose the Guilt!

A sigh of relief, courtesty of our friends at the American Lung Association. Got this from their excellent email, The Weekly Breather (which I wish I had more time to read):

Day Care May Cut Kids' Asthma Risk...WebMD reported on September 9 that infants and toddlers who attend day care are less likely than other children to develop asthma symptoms by age 5, a new study shows. The research adds support to the so-called "hygiene hypothesis" -- the idea that early exposure to infections and germs helps protect against allergies and asthma.For the full story: click here

See? You're not such a bad mom after all. Don't you feel better now?

Place Blame for Asthma Here: Stomach Germs and Peanut Butter Sandwiches

Yesterday, my co-worker shared with me an article that stated that eating too much peanut butter during pregnancy may increase the likelihood that your child will develop asthma.

Now I know that I craved - and indulged in - many peanut butter sandwiches during one of my pregnancies...but was it child one, child two, or the miscarriage before both? (I know it wasn't child three - I was too busy to EAT during that one!)

It's a theory I can get behind because, having the traditional "mother's guilt", it puts the blame on me. I can take responsibility for my kids' asthma once and for all. Pretty messed up, huh?

But another theory that seems a little sane is this one: A study at the NYU Langone Medical Center found that H pylori, a bacterium that used to be common in the human stomach, seems to prevent pediatric asthma, allergies and hayfever. Prior to WWII, this was a familiar germ, but with the advent of antibiotics and antibacterials, resulting in cleaner homes and schools, it's become pretty rare. Here are some stats and quotes from the study worth sharing:

"In our study we asked the question, is there any relationship between having H. pylori in the stomach and having asthma and other allergic disorders," said lead researcher Dr. Martin J. Blaser, the Frederick H. King Professor of Internal Medicine and chairman of the department of medicine at the New York University Langone Medical Center in New York City.

"We found a strong inverse association between H. pylori and childhood asthma, childhood hay fever and childhood allergies," added Blaser, who's also a professor of microbiology and has studied H. pylori for more than two decades.

Blaser thinks that H. pylori may protect the body against asthma. "When children have H. pylori in their stomach, their immune system is different than if they don't have H. pylori," he said.

...

Among children in the survey, just 5.4 percent born in the 1990s tested positive for H. pylori. In addition, 11.3 percent of the children under 10 had taken antibiotics in the month before the survey.

Blaser and Chen found that among children 3 to 13 years of age, those who carried the stomach bug were 59 percent less likely to develop asthma than children without H. pylori. These children were also 40 percent less likely to suffer from hay fever and other allergies, such as eczema or rash.

Among children aged 3 to 19, the researchers found that those who harbored H. pylori reduced their risk of asthma by 25 percent.

OK...if there's an experiment related to this study, can I bring my kids?

Unhappy Mothers Day

Where to start, with everything going on around here?

B is having an "off" day - getting frustrated easily, getting stuck in grooves that we can't quite pull him out of. There are days when the characteristic autistic behaviors are more apparent. This is definitely one of them.

Ozzy started Mother's Day with a time out -- how many time do I need to ask the kid to get dressed? How many???

(B is like a little timebomb at the dining room table right now. He's working on one of his mysterious projects, and he's either going to throw it down and rip it to shreds - or burst into tears. I keep hearing say, "I hate paper. I hate it!" I'm watching him, ready to help or hug when needed.)

Ozzy, by the way, had a BRUTAL asthma attack last Sunday. DuoNeb was only holding him for an hour at a time, and when it wore off, he'd cough until he gagged or vomited. It was horrible, and we had to put him on orals for two days.

Ig, last but not least, was diagnosed with his 50,000th ear infection, we had to put him on Omnicef and schedule surgery for new tubes and adenoid removal.

Within two days of starting the antibioitics, he broke out in a flat, lacy rash for which I promptly called the peds. After three days on Omnicef, they told me his ears were clear and took him off the stuff. That was Tuesday.

Today, he's pulling at his ears and running a low-grade fever. Are you surprised?

...so needless to say, it's been a rough couple of weeks. All I wanted for Mother's Day was a nice diner breakfast and a trip to the zoo. I wanted to see my kids having fun, and I didn't want to have to yell at anyone. Not so much to ask, right.

Apparently it was. I had three out of four boys seriously grumpy. Dad, B and Ozzy were all cranky today. What a bummer! Thank goodness Iain was happy.

It's still early, so hopefully we'll make up for it on the playground later. I just want to have some fun with everyone before Ig's surgery on Thursday.

I'm going to take a little nap now - my Mother's Day present to me.

To the rest of you SuperMoms -- enjoy your day!

Utter Madness - But We're All OK

I've been the absentee blogger lately, I know...

In a nutshell, I left the job I've loved for four years and started someplace new. That was about 7 weeks ago now.

The new job is fine -- I have a decent life/work balance, which is critical for me. Obviously.

It is taking a long time to get ramped up though, which is frustrating. I don't really have a budget for my online marketing programs, and the two guys I work with, who have complimentary positions, are very, very smart, and very, very busy. So I feel kind of stupid and lazy right now. It's a little challenging.

At home, I'm still getting used to the routine of the new job. Different commute. Different stress level...scared to be late or to ask to work from home...but I do both anyway...

The kids are doing well regardless. I'm definitely yelling at them a little less. The stress of the new job is a heck of a lot lower than the stress of the old job as it was petering out.

The old job was so wonderful...loved every minute of it until the company was acquired. Then it was something like watching a beloved grandparent succumb to Alzheimers. Everything you love, all the memories just dying away, until you don't recognize each other anymore. I'm writing in a rush right now...but you get the idea. It was painful and horrible, but I know the company I loved really doesn't exist anymore. And I don't recognize -or trust - what's grown in its place.

So those last few weeks, with a new boss and a new CEO, were VERY stressful, and I felt like I was losing patience with the boys a lot in the morning. I'm not, by nature, a yeller, so it was weird for all of us to have me screaming at them (especially Ozzy, who's just going through a PHASE right now).

Things are quieter now, but it's still challenging. And I dont' feel like I have time for anything at all these days. By the time I've gotten those three guys off to bed, I want to go lie down myself!!

Anyway...enough about me! Here's the deal with the guys:

• Ozzy: Coughing. I went to on my first business trip in a while - and my first plane ride in 8 years! - this past week, and of course he had a flare. I got called on my cell phone mid-meeting in Atlanta...he was being sent home from daycare because he was coughing so much! I called the husband and made sure he understood the action plan. Then called every two hours to check in. Sounds like it was a rough day or two, and he's still coughing at night, but he's doing OK overall. He was dropped from Flovent 110 to 44 about two weeks ago, and taken off Singular, so we'll evaluate the meds situation if he's not better in a few days.
• B: Still coughing a bit. It's been about three weeks now, and he's doing MUCH better. Oddly, he's on Augmentin right now for (of all things) a severely infected hangnail. (So gross...) I suspect the cough is from a lingering sinus infection, so the Augementin would clear that up, if I'm right.
• Ig: Bad diapers, a few sleepless nights, and digging in the right ear. Could we be en route to another ear infection? If so, we're down for new tubes AND an adenoidectomy. We'll see...

I *may* have heard a cough from Ig this morning, and he did insist on taking his blankee to daycare today. Never a good sign.

Sorry for the very long and poorly (quickly!) written post, but gosh it feels good to bring you up to speed!

Oz is FOUR today!

Happy Birthday, Monkey! I wish you a year free of flares and Orapred.

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Singulair: Believe the hype!

I hope by now you know me well enough to know that I'm no alarmist. I report, I offer my opinion, but I generally don't freak out over things.

So with the news of Singular and possible suicide ideation, along with other emotional symptoms, I followed the news, but I didn't react much. My kids are so young...is there really any risk or suicide, even of depression, in a six-year-old?

Apparently, there is. We went to the pediatric pulmonologist on Thursday, and she's taking all kids off Singulair over the next month.

Now, this is a woman who is against anti-bacterial hand soaps, who aggressively prescribes inhaled steroids...and someone I tend to think of as reasonable and level-headed.

For her to take B and Oz off of Singulair so abruptly was a bit disconcerting. The office is taking the new - and still unconfirmed - research very seriously. They even sent an email to their patient base about it.

B's been on Singulair since he was 26- or 27-months old, way before his ASD diagnosis. We never considered that the night terrors he suffered might be from Singulair. Nor did we consider that the lack of mirth we've seen in him since September might be related to the drug. There's been so much ELSE going on...Kindergarten, for starters! New friends, my husband's new job and new schedule....MY new job...so much. It would be hard to trace the changes in him back to just the Singulair.

But we'll see. He's got a cough right now - first one since the early fall - so he's on the stuff through May 8.

Ozzy's already off, and all I can say is that I'm HOPING for an improvement in behavior!! He's been on Singulair for as long as I can remember.

Lately, his behavior has been horrible. He's been tuning us out, talking back - he even HIT me yesterday. (He was tired, so I'll cut him some slack...but really, that's unacceptable!)

Maybe there's some small chance that the Singulair is behind that nasty attitude.

Maybe I'm totally dreaming.

Ig's Ears

As good as my pediatricians are, sometimes they're in a rush. They've got a busy practice.

Today, I got one of the docs to slow down and read the file.

Ig, as it turns out, DOES have another ear infection. Dr. G listened to my reports about Ig's two weeks of low-grade fever and persistent cough (upper respiratory, thankfully). She flipped through his file and noted that we'd had a rough time pretty much since New Year's. Lots of coughing, fevers, plenty of ear infections. I'm not exaggerating when I tell you the kid was there every two weeks.

She prescribed a 10-day course of Omnicef, but recommended we keep him on for two full weeks if he's not completely symptom-free.

She also recommended that we see the ENT again, since he's had so many ear infections. Hopefully we won't need tubes again. Although, we all slept a lot better when he had them!

Mostly Quiet

It's been a little quieter around here as allergy season looms ahead!

Ig is still coughing a bit, and I do believe he has an ear infection...but overall, not so bad.

The big headache is that we've changed insurance, and the new company - ExpressScripts - is giving us a hard time filling B's Singular Rx. Shocker, right?

Anyway, taking Ig to the peds AGAIN this afternoon for the ear, so I'll keep y'all posted.

New Study -- Aspirin Reduces Asthma Risk Among Older Women

From the Washington Post:

Taking a small dose of aspirin every other day seems to reduce the risk of developing asthma among older women.

The study, appearing in the online issue of Thorax, essentially mirrors a similar study in which men taking aspirin saw the same
reduced risk.

Interesting, right? But check THIS out...

The incidence of asthma is on the increase, possibly due to obesity, dietary factors, exposure to antigens and environmental factors. But the trend also coincides with a decreased use of aspirin as people have switched to other over-the-counter pain relievers, or have avoided aspirin use in children due to concerns about Reyes syndrome.

That led some researchers to wonder whether the reduction in aspirin use was contributing to the rise of asthma.

Discuss amongst yourselves...

Oz Is Better; Ig Is Coughing

It just never ends!

We finally managed to get Ozzy's cough under control Friday afternoon, after about 36 hours of DuoNeb treatments. It was pretty scary for a while there -- we were prepped and ready to take him to the ER if needed. And I'm amazed that we made it through that one without orals!

...but then, he's still coughing a little, so I should probably refrain lest I jinx myself.

His fever, by the way, hovered over 102 for a full three days, but then just broke out of nowhere Saturday afternoon.

Meanwhile, it's been two weeks since Ig was sick, so I guess we're due there. I heard him cough once or twice yesterday, and then at dinner tonight he let out a few seriously croupy barks.

So...I'm going to bed now. Since I probably won't sleep. Again.

Holy Virus!!!

I just heard from the PP ... based on my description and the peds assessment, they think it's a virus that they're seeing a lot of. Here's the skinny on the virus --

• Fever of up to 105 lasting 5-7 days.
• Cough is so acute, they're recommending DuoNeb every 4 hours
• They are hospitalizing kids with this

If I can be selfis and even sacreligous for a second here: 5-7 days?? God, did you plan this because I was starting a new job? Is this a sign that I shouldn't have left the old one? I mean, my new boss is a mom, too...but a whole WEEK???

Secondly, how scary and POOR OZ! I've never heard my PP, as aggressive as she is, prescribe DuoNeb only every four hours. She usually has us alternate between DuoNeb and albuterol.

I just pray that 1) Oz gets well quickly and without a trip to the ER and 2) that the others don't get this.

Think of me at 4:00 AM while your sleeping and I'm nebbing away. I hope they have Law & Order reruns on then.

Oz is sick - not strep, not flu

Terrible day! I started a new job last week, and while I *will* have flexibility ultimately, I do need to put on a good show and be at my desk for now.

But Oz let out a few croupy coughs overnight Tuesday, and had a moderate cough yesterday. I started albuterol, just to be safe.

Last night, he woke up with a fever, and my husband ("B") stayed home with him today. I gave him some ibuprofen a neb before I left for work, and told B to call me if he had any concerns.

B called at 11:30 - Oz was coughing uncontrollably, until he gagged. He'd already had a second neb, and I told B it was OK to give him Dimetapp. (Yes, I know about the warnings. Please don't call family services on me. The stuff WORKS, and the situation was dire!)

Dimetapp didn't work, so B gave him DuoNeb, which helped a little, but I was already paging the peds and the pediatric pulmonologist from my cube!! The peds were able to see him immediately.

Of course, B's car is in the shop and I have the (hideous, horrible) minivan, but thank goodness our neighbor was home and willing to loan us their car. I'm sure Oz will love sitting in their daughter's Disney Princess car seat.

They tested for strep and flu (both negative) and chalked it up to something viral. They said his chest sounded clear. Unsurprised sinced the kid had three nebs in less than four hours.

I'm waiting for a call back from the PP.

Keep y'all posted --

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!

Hark! I hear a cough!

Just heard a NASTY cough from down the hall...think it was Ig.

No surprise. He was wiping his nose on his hand (love that) and digging his finger way, way into his ear while I was reading to him tonight.

Might I just add that the timing is ideal, since I started a new job on Monday. I absolutely need to tell them I need to work from home ALREADY because one of the boys is sick. Nothing like showing the new boss what a liability you are early on.

At least she's got kids, too.

New Vaccine Risk from Merck

Y'all k now how much I love Big Pharma and unnecessary vaccines... (Polio=necessary, chicken pox=unnecessary.)

Here's some exciting news from our friends at Merck!

Ig Again

On 1/21, I posted that Ig had Scarlet Fever.

On 2/7, he was diagnosed with Strep AGAIN! And he ruptured his eardrum - AGAIN. What kind of luck do this boy and I have? And is it luck, or is it just daycare?

He's been on antibiotics since Thursday, and I started nebs on Saturday because his cough just had that edge to it. It only took two nebs for the cough to all but disappear, but I'm keeping him on albuterol for a few more days to be safe.

On another, sunnier note....posted a new link in the side bar to The Shortest Blog in the World. If you need a good laugh (like I frequently do) check it out!

Jennifer's Question on RSV/Asthma

Had to post this one -- probably a lot of this, now that it's Flu/RSV season:

Hello,
I came across you blog by searching google for asthma treatments. My son 8 months tomorrow has had RSV once and now pneumonia twice. This since early December.My head is spinning thinking that this is potentially a lifetime problem. He is on Orapred now with albuterol Not to mention Amox. for an EI. He was on singulair after the first bout with pneumonia. I thought it was working, but then he came down with a cold and within a day it was in his lungs. The dr. is going to switch him to pulmicort now I just have so many questions. I was wondering if you could perhaps help me or just talk me through it

OK...so the best advice any parent of an asthmatic child can give you is find a pediatric pulmonologist or asthma/allergy specialist, if you haven't already. Pediatricians are generally wonderful, but because asthma - particularly in a child as young as yours - can be VERY subtle, a specialist (if you have access to one) is the way to go.

I've found that finding the right combination of meds is an exercise in trial and error, even with the best doctor. I admit surprise that your son wasn't put on Flovent or Pulmicort from the start, but all docs have their own preferences.

It could be that your son will be what seems like a LOT of medication for a while. My oldest was best on Flovent 220, Singular and Nasonex when he was 2-4 years old. I've never met a mom who was happy about all this maintenance medication, but the good news is, it typically is NOT a permanent situation.

B was on a ton of medication for a year or so before we were able to lower the Flovent and phase out the Nasonex. And once we took his adenoids out (sinus infections were his biggest trigger) we were able to phase out the Flovent as well.

Now he's just on Singular, and has maybe two asthma flares a year -- and they've been mild ones, too.

My other guys are still on Flovent, but comparatively low doses, and they're doing well so far.

I do think that our PP is more aggressive with medication than others, but it seems to have worked will for my boys.

One resource I highly recommend is the Allergy and Asthma Network. You can call them directly with your questions and concerns. (They also offer discounts on medical equipment - definitely a bonus!)

Probably Parvo

Doc just called...probably Fifth Disease, but if he has a fever in the AM, we'll take him in for a Strep test.

Awesome. I'll bet the other two have it, too. That would explain why Ozzy's been such a whiney little cranky-pants all day -- and why he was running 100.2 yesterday.