Diagnosing asthma in toddler

[Heliotrope]

My 20 month old has been very healthy until recently.  Almost two months ago she had chicken pox, with accompanying nasal congestion and a lingering once a night cough (around 11:00 most nights for about two weeks).  She then appeared to start another cold and 24 hours into it developed breathing problems - rapid breathing, grunting, retractions at the collarbone - along with a fever and fatigue.  Following an x-ray (showed "opaque area") diagnosis of bacterial pneumonia.  She was treated with a nebulizer twice during our afternoon with the pediatrician and we took it homebecause it seemed to help some with her breathing.  Her recovery was uneventful following one dose of injectable antibiotics and 10 days of amoxi.

Two weeks later she came down with a bad virus going around her brother's preschool - developed congestion and a fever (100) and 24 hours into it began grunting.  ER exam shows saturated oxygen level of 97 lungs sounded ok.  The next morning she was no longer grunting but was retracting along collarbone and slightly in her ribs.  Back to the pediatrician who said her lungs sounded rough and her breathing was a bit fast - treated her with a nebulizer and again there was some response.  MD says we now need to consider asthma but that it is just a wait and watch situation at this point.  No asthma/allergies in immediate family but one uncle and grandma have asthma.  No mystery coughs or wheezing, never had any problems with colds in past.  We are very scared and trying to understand how likely it is that this is asthma and that it will be a chronic condition.

[National Jewish]

Viral infections like a cold or chicken pox can cause inflammation of the airways of the lungs.  When this occurs your daughter may have difficulty breathing, especially when she is active or laughs.

After the infection is gone, it is possible for the inflammation to linger.  This inflammation can last for several weeks.  Sometimes this inflammation may linger for 3 to 6 months.  Eventually the inflammation will go away, and then the difficulty breathing will stop.  This is called reactive airways disease (RAD) and behaves a lot like asthma.  This inflammation often clears more quickly when it is treated with an inhaled steroid medicine like Pulmicort Respules™ (budesonide inhalation suspension), which is given by nebulizer to treat asthma.  It may be possible to keep your daughter well and avoid the oral steroids by using the Pulmicort Respules™ (budesonide inhalation suspension) every day.  Usually this medicine does not provide immediate relief of symptoms.  It may need to be used every day for several weeks to months for it to help.  Your daughter’s doctor is the best judge of this.

Asthma is a chronic form of reactive airways disease (RAD).  So when this continues, it is generally considered to be asthma.  A lung problem such as asthma can cause a cough.  A cough can be the only symptom of asthma.  It is typical for asthma to be worse at night.  Also it is common for infections to trigger asthma.  For some people infections are the only thing that triggers their asthma.  For other people infections do not trigger their asthma at all.  Asthma tends to run in families, but sometimes there is no family history of asthma.

Testing can be helpful to show if this is due to asthma or RAD.  Generally testing starts with a simple breathing test called spirometry.  This test provides detailed information about how the lungs are working.  It will show if there is obstruction in the airways.

For spirometry to be helpful in determining if this is due to asthma or RAD, children need to be able to follow directions well.  Generally children need to be at least school age to do this.  Until children are old enough to do this testing, they are commonly treated with asthma medicines by nebulizer when they have symptoms and/or to prevent symptoms.  So for a 20-month-old this really is a wait and watch situation.

[Christie2004]

You can have something known as asthmatic bronchitis, which is simply an inflammatory response by the airway paths in response to a recent infection.  The inflammatory response can narrow the airways and cause wheezing, which will ease over time as the infection clears.

This condition can linger for weeks following a respiratory illness.  If it becomes troublesome, causing shortness of breath, moderate wheezing or frequent coughing, it can be treated for a short period of time.