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Six year old and asthma
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Six year old and asthma

My son caught his first cold at one year old.  He developed wheezing and was given albuterol in a nebulizer.  From then one, he had problems with SOME colds.  Certain colds he will just get over, but others he will start this horrible coughing.  They have had to place him on oral steroids during this.  He is on singulair, but not sure that does much.  He doesn't catch a whole lot of colds, but when he has one, they last a long time.  He is six now and they got him in for allergy and asthma testing.  He didn't really have any allergies (one weed and 2 trees showed a slight reaction).  He is very smart, but a lazy child.  He stays at home with me and I home school him so he has had me to do a lot for him.  He will not exert energy to pull something open or something of that nature.  When they did the asthma breathing test with him, he was blowing, but not hard.  He did it wrong several times (possibly every time).  The then gave him albuterol and made him do it again.  By then, he understood the process more.  He still did it wrong, but I think his effort was a lot better.  As a result, it showed a 23% increase after the albuterol and they said he has asthma.  I kind of doubt this info.  He had no change in breathing from before and after the albuterol and he is not sick at the moment so he has no cough... nothing.  There is no sign of any breathing problem.  I asked the nurse about it and she said maybe he is used to not having enough air.  If his breathing is that bad though, are there not SOME signs.  He runs and plays all day long.  He has never shown an issue other than while sick other than MAYBE a post nasal drip problem.  They want him on qvar daily now.  I am hesitant to start him on a daily steroid when he only has an issue once or twice a year (this year was twice... very bad year).  I am doing the peak flow with him at home and it is always the same reading (not a good one), but he is not doing it right here either.  He is using  a very low effort.  I wonder how likely it is for that test to have been inaccurate?  Do any of you have experience with placing a child on a daily inhaled steroid even when they are just fine all year around other than a few colds?  Is it possible he can have such a bad breathing score if it was accurate, when he has NO symptoms or no problems.  He moves ALL of the time.  The only issue I ever notice is he clears his throat upon waking.  He does not cough without having a cold, and not at night.  I asked him if the albuterol makes him feel any better, and he always says he feels the same.  He never complains of being short of breath.  I don't want to go against the doctors, but I don't want to place him on something so extreme if it isn't needed either.  I appreciate any help,


Danielle
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Avatar_f_tn
I'm a chronic Asthmatic, it doesn't seem as if he has asthma usually a sign is short of breath, weak and a dark circle under the eyes if its an actual problem, i'd suggest getting a second opinion and the tests were innacurate if he wasn't trying to do it. Could be lack of motivation. With the peak flow at home try saying if he does it like you do than he gets a hot wheel or something that really interests him, will get him to try to actually do it as well as give an accurate reading. Below 300 is a realllly bad sign. Good luck!
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Avatar_n_tn
Since you have had thyroid problems has his thyroid been checked? If it is his sinuses can you get a hold of a pediatic nasal wash-- I think neilmed makes one.

achilles2
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215461_tn?1331866365
He blows 150 every time.  He did get it to 200 once, but not sure if he cheated.  I did look it up on a chart for his height and 150 is 70%.  He did do 170 a few times, but its really hard for him to get the whole thing in his mouth and then blow so I know the readings are not very accurate at the moment.  He does semi dark circles when he is sick but at that time he does have some type of airway problem.  I guess I should probably get a second opinion like you said.  It is just too questionable at this point.  He scored higher on the peak flow today with nothing then after they gave him the albuterol yesterday when his lung functioning was supposed to be 23% better.   It's so confusing to me, because I notice no weakness or shortness of breath.  Thank you for your answer.
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215461_tn?1331866365
I have asked the docs about testing his thyroid, but they don't really seem too concerned over that.  They are doing immune system testing right now.  I have not tried anything with the sinuses.  I've just been trying to figure out what it is exactly that he has.  It's so scary because I want to do the right thing and treat him, but I am just not sure about a daily steroid.
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215461_tn?1331866365
Yikes ignore all my mistakes.  Unfortunately I type a lot faster than my brain works lol.
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Avatar_n_tn
The experience has been with my asthma that when I have more sinus issues than typical for me (I have year round hay fever) that this will affect it and make it worse. So you might want to look at the sinus rinse it has been a life saver and saved me many sinus infections.
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215461_tn?1331866365
Thanks for the info!  I'll look into it.  The seemed sure he had asthma, but it's so confusing to me because he shows no symptoms other than when sick (I know he has it or something then).  He has had lung xrays and o2 tests and those were okay too, so I am just hesitant to believe he has such extreme asthma from one test he doesn't even do right.  Can one just learn to live and never have any symptoms with bad lung functioning like the nurse said?  Surely something would show up other than just during a sickness right?
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Avatar_f_tn
I tend to agree about getting asecond opinion, as well as checking into the sinus issues.  While it's quite common to have worse asthma troubles whenever sick (I do also), the fact that you say he has NO problems at other times with coughing and/or shortness of breath, does make me wonder if he does not actually have asthma.  He may have what they refer to as "reactive airway" - basically meaning when his airways are irritated by illness, that's when his symptoms occur.  Cough alone CAN be an indicator of asthma - I actually usually tend to have increasing cough as my first inclination/symptom of an oncomong asthma attack - and the cough is also the last thing for me to "go"..

The idea of putting your son on a daily steroid is a scary thing - especially if you're not 100% sure he has asthma and needs it.  To me, and remember, I am not a medical professional, only a fellow asthma sufferer - since he symptoms/troubles are actually relatively infrequent (pretty much only when sick) - it seems a big step to go from him using no inhalers to using a daily steroid inhaler.  On the upside of the inhaled steroid, though, the amount of steroid inhaled is a good bit smaller dose that he would be getting than when he has to be placed on the oral steroids - so therefore, a lesser chance for side effects, although that chance does still exist and some steroid side effects can be pretty severe/scary.  Of course, too, with the inhaled steroids, the steroid is much more readily getting to the area o fthe body that really needs it - the lungs/airways - as opposed to the oral steroids which are systemic.

I think my first step would be to have his sinuses evaluated and checked - I'd suggest actually taking him to a pediatric ear, nose and throat doctor.  They can also check his tonsils and adenoids (adenoids) (the adenoids (adenoids) can cause sinus issues if they are inflamed/infected) as well.  His clearing of his throat in the morning could very well be a sign of post nasal drip which, of course, can be worse at night simply from laying down all night - and if his sinuses are clogged up, he's more apt to be breathing through is mouth rather than his nose, which also can cause throat irritation/need to clear the throat because it gets so dry.

As far as doing the peak flows with him at home - it's definitely a good idea to keep track of them.  Try to make it a "game" - perhaps put a bright sticker on the peak flow tube at the point that is a "good" level and ask him to see if he can make the little ball reach that sticker - perhaps also giving HIM a sticker or something of that sort if he does.  Or perhaps create something along the lines of a "chore chart" type thing - where for every time he's able to get the little ball up to that sticker on the peak flow meter, he gets a sticker on the chart and after so many chart stickers, he gets a special treat - maybe a movie - maybe a trip to McDonal's - something that he likes.  This may be an incentive for him to give it his best effort since you've said sometimes he just seems lazy about doing it so may not be giving it his best effort.  Of course, it's also imperative to make sure he knows that if he CAN'T make the little ball get up to the sticker on the peak flow, that he's not bad or he's not doing something wrong - it simply means that he might be having breathing difficulties that he, himself, may not really recognize.

does he currently also have an albuterol inhaler or nebulizer meds that he is using?  How often is he using it?  If he's using an inhaler, is he using a "spacer" with it?  If he's not using a spacer, I'd definitely suggest asking his doctor to give you a prescription for one.  It's like an additional little tube that the inhaler goes in one end and your son will inhale from the other end - however, with the spacer, his inhaling of the medication does not have to be coordinated in time with the pressing of the inhaler - basically, the medication will go into the spacer and then be inhaled from there.  Many children find it much easier to use an inhaler with a spacer because it CAN BE difficult to coordinate that inhale and pressing o fthe inhaler - even for adults!  If he's using albuterol nebulizer, is he using a face mask or a hand held mouthpiece?  If he's not currently using a face mask, think about getting him one - most pharmcies carry them and you don't need a prescription for them - simply as for a pediatric nebulizer mask - again, this will make it easier for him to get the full benefit of the nebulizer treatment because it allows him to have his hands free to be coloring or reading or doing something else whil ethe treatment ishappening, making it much more likely that he will sit still for the entire treatment.  It's also difficult sometimes for children to sit throug the entire treatment holding the mouthpiece because they want to be talking, etc., and if they ARE talking, they are not getting the medication as well - whereas with the mask, they can talk while getting it and it doesn't make any difference.

I hope some of these suggestion are helpful and also hope that you find some good help for your son.  Please keep me posted.
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215461_tn?1331866365
Thank you for all of your help.  I appreciate the thorough response.  I am going to get a second opinion from an ENT on next Friday just to make sure its not post nasal.  I have noticed working with my son he is getting the hang of the peak flow better now.  I know the first test was probably really wrong.  
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