chronically ill child

[Williams29]

My 28 month old was first diagnosed with a sinus infection when she was 13 months old, she has been sick ever since. She has been on prolonged antibiotic therapy over 10 times with shorter doses in between that did not help, she has been seen and diagnosed with sinus infections 15+ times, each one worse with increased coughing and chest congestion and each one taking longer to recover from with only about 6 days of complete wellness in between. She has been to an ENT and has had her adenoids (adenoids) removed, she was sick with a sinus infection within two weeks. She has had several sinus CTs done and chest films. Recently we saw a  pediatric pulminologist who diagnosed her with RAD and has her an Pulmicort, Zopenex, Prednisolone, Singular, Previcid, Duradryl, and Nasanex, and a daily dose of amoxicilin, she has been on and off Zyrtec for 1.5 yrs. with no real relief. He is working on a preventative maintenance plan as well.
She has had a full immunology work up and every thing looked ok. She was borderline on her IGG type 56 and type 4(?) but none of her dr.'s seem concerned about that.
She is not sleeping or eating.
What is the long term effect of being so heavily medicated for such an extended period of time and what would be a proper maintenance program for a child with chronic sinusitis and RAD? Is there anything we could be over looking that is causing her to stay sick?

[National Jewish]

Sinusitis is an inflammation of the mucous membranes that line the sinus cavities.  Inflammation of the sinuses could be due to an allergy, an infection, or ongoing exposure to an irritant, such as pollution or smoke.  Symptoms can include a headache or pressure in the area of the sinuses, a stuffy nose, achy teeth, an odor coming from the nose, postnasal drip, cough, sore throat, laryngitis, lightheadedness, constant low fever, and thick, yellow to green nasal drainage.

The best way to identify a sinus infection is with a sinus CT scan, although sinus x-rays are a decent alternative.  A sinus CT scan will also identify if any of the openings that drain your sinuses are blocked.  If your daughter’s symptoms are due to sinusitis, they will last as long as the inflammation continues.  Please read our Sinusitis MedFact at http://www.nationaljewish.org/medfacts/sin.html for information about ways to clear up the inflammation.  Please check with your daughter’s doctor to see which of these would work best for her.  Usually sinus surgery is considered when these techniques have not been helpful.

The most common cause of sinusitis is an infection, especially when the mucus is green.  Sinus infections can be difficult to treat since they respond slowly.  When any of the openings that drain your daughter’s sinuses are blocked it will take longer to clear a sinus infection.  If a viral infection is the cause it’s a matter of time until the sinusitis clears on its own.  When a bacterial infection is the cause your daughter may need to take an antibiotic for at least 3 weeks.  Bacteria can become resistant to a particular antibiotic, especially when that antibiotic is used repeatedly.  When this happens your daughter will need to be treated with a different antibiotic to clear the bacteria.  Even after an antibiotic clears the infection, it is possible for the inflammation to linger.

Infections like sinusitis can cause inflammation of the airways of the lungs.  This inflammation can cause coughing and chest congestion.  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 cough and chest congestion 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.  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.

[Oxygen7]

I'm not a doctor but I do STRONGLY suggest that you have a Sweat Chloride Test done on your child to test for cystic fibrosis...I'm not saying she/he has it, remember i'm not a doctor.  But with the reccurrent sinus problems, being sick, and not eating those are all signs that are linked to CF.  Ask your pulmonologist to do a sweat chloride test, even if it does turn out to be negative, atleast it's something you can try that might give you answers.  I am a respiratory therapist at a children's hospital and I work with CF patients on a daily basis.
I hope this helps!