Toddler and RAD

Good morning,

Prior to this fall, my son didn't haven any obvious "asthma" problems.  He had one incidence of wheezing in the spring that lasted two days, but never got severe enough for us to worry about it.

This fall, following an exposure to mold and fiberglass, AND following a cold, my son developed a severe wheezing episode.  We waited for it to abate, but after about 8 hours had to take him to the emergency room for a breathing treatment. He was given albuterol and an oral steroid, and was fine.  Our guess at the time was that the exposure to mold and fiberglass had done it (my wife, who has asthma, also had a very severe asthma episode at that time).

A month later, my son caught a very mild cold.  Surprisingly, to us, this also ended up in a very severe wheezing episode, worse than the first time (less rattle, more tightness).

The doctor was reluctant to diagnose asthma, but suggested that this might happen to my son every time he gets a cold.  He put us on a cromolyn inhaler, twice a day.

My son is currently 18 months old.

I have two questions:  
This being the flu season, we are doing our best to keep the kid away from people who might have flu.  Our main concern is that by taking my son to the hospital for rescue treatment we will be exposing him to the flu.  Can/should we call ahead to the hospital to see if we can effect some respiratory privacy in the ER?

Also, how effective is cromolyn at controlling something like
this?  These days, we jump every time he sneezes, and have given him an albuterol treatments on several false alarms.

[National Jewish]

Viral infections like a cold can cause inflammation of the airways of the lungs.  This inflammation can cause wheezing.  After the cold 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 wheezing will stop.  This is called reactive airways disease (RAD) and behaves a lot like asthma.

When this continues, it is generally considered to be asthma.  It is most likely that your son does, indeed, have asthma.  Having a parent with asthma and then having repeated symptoms assures this as the diagnosis.  Most children this age with asthma are triggered by respiratory infections and by rapid changes in temperature.  Both of these are most common in the winter months.  This is the rule and not the exception.  Cromolyn is not very likely to be able to prevent the attacks you have described.  Cromolyn, while very safe, is also a very poor preventative agent when attacks are as you have described.

I would advise seeing a pediatric pulmonologist or pediatric allergist to get on effective anti-inflammatory medicine for the rest of the winter.  Also be sure you have your nebulizer and albuterol at home.  In the spring, you can determine how long these medicines need to be continued and which ones.