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is it really asthma? also blue fingernails
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is it really asthma? also blue fingernails

My 3 yr old son has asthma (cough only--no wheezing) and allergies for which he takes pulmicort nebulizer 1x/day as well as nasonex and claritin.  This controls asthma well day to day but when he has breakthrough coughing (usually triggered by a virus to start and then worsening) he takes albuterol but this does not seem to work.  Also when he is active (as any normal 3 yr old boy is!!!) he has rapid/hard/loud breathing but doesn't progress to anything worse.  He had a T&A due to sleep apnea and an echo to rule out heart problems that may be causing blue toenails/fingernails.  The cyanotic episodes started before he was dx w/sleep apnea and I thought it would resolve after the T&A as they only occurred when waking in morning or after a nap but following the surgery he had a hard time keeping sats up even with 50% oxygen (O2 sat at 90-92%) and if no oxygen thay would drop to 78-80%.  It took 4L O2 via cannula to get him to 98%!  Anyway, the next morning he was finally consistently at 96% w/out O2 and we went home only to start having more significant cyanotic episodes when he got even a little upset (whole hand and lower half of face would turn blue until he calmed down).  He went on like this for about 3 weeks and then nothing for about 6 weeks.  In the meantime he had the echo which was normal.  The episodes of blue finger/toenails has started again but they are only periodic and not assoc. w/rapid breathing and only last about 15-30 minutes.  My questions are these:
1: Is it really asthma in the first place--he never wheezes, even when he is sick--or could it be something else chronic?
2: what else could cause blue fingernails/toenails? (doesn't seem to be re: to coldness either)
3: what other medications besides albuterol could be helpful when he has breakthrough--the only thing that works to knock the cough out is a short course oral steroid on top of daily pulmicort

Thank you in advance for considering my questions and sorry for the long post!        
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242588_tn?1224275300
Your son may or may not have cough-variant asthma but his cough could worsen and his airways become inflamed and wheezy with a viral respiratory infection.  This is a common scenario.  But asthma, with the exception of severe acute asthma flare, is not associated with cyanosis.  More likely causes of cyanosis would include cyanotic congenital heart disease or abnormal hemoglobin, the substance that carries oxygen within red blood cells.  The normal ECHO does not rule out shunting of blood in the heart, especially if a "shunt study" was not performed, and even if it was.  Nor does it rule out shunting, for example in the lung, or elsewhere in the body.

Also, especially in the presence of abnormal hemoglobin, blood oxygen saturations determined by pulse oximetry, can be erroneous.

You may want to seek consultation with a pediatric cardiologist and, if no shunting or other heart problem is found, with a pediatric pulmonologist.

You may also want to discuss the above with his primary doctor.
9 Comments
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306245_tn?1244388567
I sent you a message in your mail box here on the site
Michelle
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Hi, You dont have to have a wizz in order to have asthma, I have had it all my life and they have the hardest time trying to find out what is going on with me when I start my coughing and they cant hear a wizz! I just got done with the same thing in the past three weeks.I was coughing and ran a 102 fever and it turned in to a big infection an then pnumonia and I still cant breath good! They say it takes months to get over a bad bout like this! Im praying it dose not, but I think it might! Im 55 though and kids get over things alot faster and heal faster too! I dont have much amune I have a heart problem
and AVMs of the GI track, so it will take longer to get over any thing! I pray things go well for yall!
                                                                                   mttownson
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Thanks for your message, I sent you a reply in your mailbox!
Elaine
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Hi Sister,

Thanks for your thought & prayers and I hope you get to feeling better soon!  I know asthma doesn't always have to have a wheeze but I can't figure out the blue finger/toenails when he isn't even having breathing problems, why his O2 sats are randomly low at times and why he breathes so heavy/loud all the time.  He is very active but I have to tell him to slow down and breathe because he gets so out of breath so easily.  Anyone having any thoughts would be appreciated!
Thanks, Elaine
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306245_tn?1244388567
Elaine, I found this and hope this helps
Signs and symptoms of asthma

If your child has been diagnosed with asthma you will be educated on the signs and symptoms to watch for. If you have any question about the severity of your child's asthma symptoms, contact your physician. Your child's asthma treatment plan may need to be adjusted to both prevent symptoms and treat symptoms when they occur.
Mild asthma symptoms
Severe asthma symptoms are a medical emergency. If your child is experiencing severe asthma symptoms, seek immediate medical attention.

    * Breathing is a little difficult and only slightly faster than usual.
    * Your child can easily speak in complete sentences.
    * Your child has a slight wheeze, couch, shortness of breath and/or tightness in the chest.
    * Skin color is good.
    * Your child is alert and knows what's going on.
    * The child is not drawing in the rib cage muscles to breathe.

Moderate asthma symptoms

    * Breathing is more difficult and somewhat faster than usual.
    * Your child speaks in short phrases because it's hard to breathe.
    * Your child has a wheeze, cough, shortness of breath and/or tightness in the chest.
    * Skin color may be normal or pale.
    * Your child is alert and knows what's going on.
    * Your child is drawing in the rib cage muscels to breathe.

Severe asthma symptoms

    * Breathing is very difficult and very fast or very slow and labored.
    * Your child speaks in single words or short phrases because it's hard to breathe.
    * Your child had has pronounced wheeze, cough, shortness of breath and/or tightness in the chest.
    * Skin color is poor or gray, especially around the lips.
    * Your child seems "out of it" and doesn't know what's going on.
    * Your child needs to draw in neck, abdomen and/or chest muscles to breathe.
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like I said before, get a 2nd opinion
michelle
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Avatar_f_tn
Thanks again Michelle!

I do believe that he has asthma but I also think there has to be something else going on.  He is so variable on the signs/symptoms that you listed above.  For example, one time he is "alert and knows what is going on" but at the same time "draws in neck" along with fast breathing and normal color but maybe another time he has blue/grey color around mouth and blue fingernails along with normal breathing.  It just doesn't seem to make sense sometimes!!!  I will be asking to go see a pediatric pulmonologist for a second opinion and discussing with them if it could also have a cardiac component.  
Thanks, Elaine
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Avatar_f_tn
Hi, I had blue finger nails all my life didnt even know it untill I was 14 and they told me I was born with,The big vains in the front of my heart, the middle one grew half and goes backfrom there ,and it is called a stnosies. I never had much trouble with it until 10
years ago a nurse give a drug, she knew I coulnt take it and give it to me any way! I went into antiflatick-shock and now I have SVT because of her, Thank you nurse! I
was told I would never have any problems because It was nornal for me and my body
was use to it that way. People would look at me and think I was haveing O2 problems.
Now that I m 55 and older it gives me much trouble. I do know it was her falut, I will
never think any thing else. I had to have abaltion done and I dont have blue nails now.I
can do more than I was able to do,  like walk along ways an not get out of breath,
but I wouldnt have had to have the ablation done if the nurse had done her job right!
Do have him checked just to be on the safe side thoe! Better safe than sorry I have aways said!


                                                                                       keeping in touch,
                                                                                             sister mtt
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Avatar_f_tn
Thanks for the info.  I know how frustrating it is to have poor medical care and I also know what it is like to have anaphylactic shock!! Although mine was because of contrast dye from a CT scan I had done and nobody could have predicted I would have that reaction (rare to be severely allergic to it).  I'm glad you are feeling better but sorry you had to have something done that should not have been necessary.  I plan to take my son to his pediatrician and discuss having a cardiologist look at him again and also a pulmonologist so I'll keep everyone posted about the results.  

Thanks for caring!
Elaine
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