3rd posting - two year old with ashthma

[Rae__0]

  My daughter is two years old. She has had many allergic reactions to known and unknown things. Her reactions consist of hives, terrible coughing, eczema,
  difficulty taking a deep breath, eyes swollen shut, and she gets very itchy. Her allergist and doctor were unsure if she was experiencing asthma. My doctor finally
  prescribed her an
  inhaler( it is not a nebulizer, but an inhaler (albuterol) used in conjunction with an aero chamber. He prescribed this in reponse to my many calls that her cough was
  getting worse. Is there anyway for a two year old to be tested for asthma? Is this kind of inhaler considered safe and are there side effects for long term use? She is
  also taking Zyrtec, Sudafed, Delsym, and a sulfer based antibiotic ( I think pedizole). SHe also has a sinus infection. She is only two years old. Are all of these
  medications safe to take together and are there any side effects? She has rarely been sick with colds, viruses, and has never had an ear infection. She does, however,
  have these chronic allergic/asthma problems. She has a very well balanced diet, but I notice that on days (only on special occasions she has candy;) she has candy
  (or any food with added sugar) her symptoms are worse. Can sugar trigger an attack? Thank you in advance.
Dear Rae:
Sorry it took so long to answer. It is critical that the diagnosis of asthma be clarified as soon as possible. There are many causes of chronic cough other than asthma. These must be appropriately excluded and soon.
Asthma is a primarily an inflammatory disease of the middle-sized and small airways of the lungs. It usually, but not always, produces wheezing on examination of the chest by a physician.
Because asthma is primarily an inflammatory disease, treatment of persistent symptoms must include medications which can control that inflammation. My Henry Ford colleague who first responded to you was quite right in suggesting that cromolyn (Intal) and corticosteroids are examples of medications which can control and prevent the symptoms of asthma and each has an appropriate role in management. Albuterol is a medication used to rescue children with asthma. It does not control or prevent symptoms in circumstances like those confronted by your daughter.
At present your daughter is taking no medications which will deal effectively with any inflammation. A child with persistent symptoms traceable to asthma should not take albuterol alone. It just won't do the job. Furthermore, there is some concern that long-term, continuous use of albuterol may have important side-effects on the heart. On the other hand, albuterol when used appropriately is a safe and effective medication.
Sinusitis can trigger or worsen asthma. Thus, it is occasionally quite appropiate to use antibiotics as a part of management of persistent wheezing.
Given your daughter's recurrent hives, Zyrtec (cetirizine) may be beneficial for that problem and provide some relief for persistent allergic nasal disease as well.
Chronic use of Sudafed (pseudoephedrine) in appropriate doses is probably safe, but should be used that way only if there is clear evidence of atopic rhinitis (allergic nasal disease). Since inflammation is an important part of allergic nasal disease, nasal cromolyn or nasal steroids are a much better choice for persistent symptoms.
The cough suppressant Delsym is less clearly appropriate for your daughter. Children with asthma have airways blocked with mucus. This mucus must be coughed up if they are to breathe better. In fact, there is little evidence that cough suppressants work at all. Despite this, they are used all too frequently.
I am less concerned about side-effects from or harmful interactions among the medications being used to treat your daughter than I am about the diagnosis of her persistent cough. A clear explanation should be available and soon.
I am confident your daughter's pediatrician and allergist know everything I have discussed. I must also presume they have already spent a great deal of time helping you identify and remove triggers of wheezing from your home. A pound of prevention is worth a ton of partial treatment. I hope you can get an appointment with them soon to discuss thses matters to your satisfaction.
With regard to sugar intake, it is now clear from controlled studies that sugar does not cause behavioral problems in children. Furthermore, sugar cannot account for your daughter's symptoms. However, things mixed with the sugar such as food dyes and nuts could. You should discuss this with your allergist.
I hope this response will help you improve your daughter's  health. The information is provided for educational purposes only. Responsibility for decision-making rests with you and your daughter's physicians. Best wishes.
HFHS.MD-HSW
KEYWORDS: Asthma, chronic cough, atopic rhinitis, sinusitis, urticaria