Bronchitis and Pneumonia in 22 month old? Could it be Asthma

[becky0999]

My son is 22 months old.  He was born about 6 weeks early, but pretty healthy.  Since his birth he has had Bronchitis 7 times and had Pneumonia twice.  It seems he is always sick and it always goes straight to his lungs.  He has never had just a simple cold.  Right now he is suffering from Bronchitis for the second time in the last 5 weeks.  He is not in daycare, so he is not exposed to many germs.

His doctor is now thinking it may be asthma.  We know he has some allergies to grass and such, so he's on Zrtec for that. No testing has been done yet.  They want to wait till he's a little older. Now they want him to start Pulimcort once a day.  I don't know rather to start it or not.  I want my son healthy more than you can imagine.  But, I don't want to medicate him if it's not for the right thing.  I asked about testing and they said there was none for his age.

Is this true?  Should I just start the medicine and see if it helps?  I know it's not right for my son to be sick all the time, but I don't know if asthma is the answer.

Please help.
Becky

[National Jewish]

This is not an easy question and certainly might be answered in different ways by different specialists.  Here is one opinion.  With the history you are presenting it is likely, rather than a small chance, that this is indeed asthma.  It may also be complicated by a chronic sinus condition.  This is often silent, but looks like a cold before getting chest involvement.  While allergy may play a role, with the history of prematurity, this is probably not a major factor, as much as the prematurity.

With respect to testing for asthma, this is not an easy procedure.  It certainly is not done in the office of a primary care physician or a pediatrician.  Lung function tests, even in 2-year-old children, can be performed in a special lab run by pediatric pulmonologists, usually in a university setting.  We do this frequently here at National Jewish Medical and Research Center.

Pulmicort Respules™ (budesonide inhalation suspension) is a fairly safe inhaled steroid that is easily administered by nebulizer.  If there is a suspicion of asthma in a 2 year old, it is not uncommon to begin a trial of this over a period of months.  In the correct dose, the risks are fairly low and far less than having one of these significant breathing problems you have described.  You cannot try this medicine for a few days or give it on and off.  That will gain nothing for your son.

If questions persist, a consultation with a pediatric pulmonologist might help ease your mind.  However, it appears your son’s doctor is on the right track.

[LukeL]

In the mean time you may want to keep him inside in an aircondtioned room at all times when it is very humid outside and when the airquality is low, and when the pollen counts are high.  

When I was little I had cancer and was always very sick and my parents said it helped out greartly keeping me in an airconditioned room during the summer months.