help with nebulizer

[kristelhasan]

My son is 3yr old is 40inches tall and weighs 42lbs. He was diagnosed by x-ray with walking pneumonia about 4 weeks ago. After treatment he was better for about 1 week. Then he started coughing again. I took him back in and the Dr said that she could hear fluid in his opposite lung this time. She put him on Singular, Nasonex, Zithromaz, Pulmicort and Xopenex with a nebulizer and Pancof-PD for cough at night. All at the same time. It kinda scares me!! He has been having up to 5 potty accidents a day. Is this possibly related? He seems to be full of energy (which he has been all along, he has never even acted sick). I have noticed after a treatment of Pulmicort that he gets a little crazy.

I am wondering if I am doing the nebulizer treatments properly. I have never used one before. What are the do's and don'ts? Is 3 teatments a day of each Xopenex and Pulmicort too much? How do you get a 3yr old to cooperate and do them? I have been doing some of them while he's sleeping. is this good or bad?

Any suggestions will be appreciated. Thank you!!

[National Jewish]

This is obviously a concerning and complex problem.  Generally getting “a little crazy” is not a side effect of Pulmicort Respules™ (budesonide inhalation suspension).  It is possible that your son’s potty accidents are related to the medicines.  However it is also possible that he is regressing because he has an infection.

Pneumonia is inflammation of the lung.  This is most commonly due to an infection.  Antibiotics will help a bacterial infection, but will not help a viral infection.  Over time the body's natural defenses will clear a viral infection.  Cough is common with pneumonia.  Some children may continue with their usual activity level without their parents being aware that they have pneumonia.  It is possible to have pneumonia without having any severe symptoms.  Generally this happens in the early stages.  This is called walking pneumonia.  It is generally best diagnosed by chest x-ray in addition to a thorough examination.  It is very possible that your son’s cough returned because his pneumonia returned, especially since the doctor heard fluid in the opposite lung.  However a chest x-ray would be the best way to know for sure.  You should let your son’s doctor know if his symptoms worsen or do not go away.  A follow-up chest x-ray is helpful to show that the pneumonia has completely gone away.

Infections like pneumonia can cause inflammation of the airways of the lungs.  Usually when this happens, your son may cough when he is active or laughs.  After the infection has cleared, it is possible for the inflammation to linger.  This inflammation can last several weeks.  Sometimes this inflammation may linger for 3 to 6 months.  Eventually the inflammation will go away and then the coughing 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 Pulmicort Respules™ (budesonide inhalation suspension), which is an inhaled steroid used to treat asthma.  Your son’s doctor is the best judge of this.

When this continues, it is generally considered to be asthma.  A lung problem such as asthma could 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.

Generally testing for asthma 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 a cough is due to RAD or asthma, 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 be tested, they are commonly treated with asthma medicines by nebulizer when they have symptoms.

To get your son to cooperate and do nebulizer treatments offer him something that he enjoys.  Some suggestions are watching a video or reading a book while using the nebulizer.  Please read our Using a Nebulizer with a Mask MedFact at http://www.nationaljewish.org/medfacts/mask.html for more detailed information about using a nebulizer properly.  We all breathe more deeply when we are awake, so the medicine will be more helpful if your son is awake when he uses the nebulizer.

[AndyRRT]

You're childs accidents have absoluitely nothing to do with the nebulizer treatments or the meds he's on. It is common for children as well as adults with poor bladder/bowel control to have accidents during coughing fits.

I'm a bit perplexed to the amount of pulmonary medications your son is one however. Walking pneumonia doesnt warrent all those medications in my 14 years of experience.

Singular? Pulmocourt? Xeopenex? Does your son even have a distant history of asthma? Was there even any wheezing? If not, then all that is an utter and complete waste. Especially the Xeopenex. That is an extremely expensive medication only intended to be used for those that are sensitive to Albuteral's cardiac effects. Xeopenex ampules cost (one treatment) approx. $30-$40/each.

Pulmicort is a corticosteroid used to treat asthma. Its used as a perventative type medicine to shrink swollen tissues caused by asthma attacks, and not for the quick relief/rescue medications like albuterol. This is concerning to me, because steroids can actually worsen pulmonary infects. Pulmicort isn't even the least bit indicated from what you have told us here.

After that one week of treatment, I Wasnt surprised that your childs doctor heard some "flyid" in his lungs. Usually, after a lung infection, like a pneumonia, the tissues that were swollen from the infection tend to "drain" (this is the best way I can explain it) This is just a way of mobilizing the secreations. Eventually, the body would have reabsorbed that fluid, or your son would have merely coughed it out...no big deal.

How long has your son been on these treatments now??

Andy, RRT, CPFT

[kristelhasan]

he has been on them for 6 days now.  I forgot one other med that he is on Oraped (6ml for 5 days).  My sister develpoed asthma as an adult and her son who is 8yr was just recently diagnosed with it.  No one else has ever had it in our family until them.

He is still coughing occasionally (7-8 times a day)and he has major drainage from his nose.

I dont like giving him all this medication either.  What should I do??

[lori g]

My son was diagnosed with asthma at 2 years old.  He has had pneumonia twice since last year.  The albuteral causes him to become very hyper.  When he had the pneumonia he was on albuteral and pulmicort every three to four hours and received three rocefin injections.  Now he is on pulmicort once a day and singulair once a day til june.  I thought the albuteral and xeopenex (?)  were pretty much the same medicine or at least used for the same reason.  It does seem like a lot of medication for him to take all at once.  You should call the doctor for reassurance about the meds.

[lori g]

Sorry...
the orapred is a steroid to help with the inflamation (inflammation) in his lungs.  My son was on that also for 5 days.

[kristelhasan]

I just got a second opinion today from a different Doctor.  She took him off the Xopenex and the Orapred.  He has no wheezing or difficulty breathing, just coughing and a little fluid in his lungs.  This Dr seems to think that it is just allergies.  Especially with the extreme nasal drainage.

She also reduced his pulmicort to just once a day.  I guess we will just have to watch and wait and see.

[Purified Air]

I have a 21 year old son with asthma but since having an air purifier in my home that covers the whole house; I've found it to help all my children even in the midst of this WI winter - we've had no colds or flu or other respiratory ills.  Here's some obvious signs in your own home that can indicate a need simply for whole house air purification.
COMMON TRAITS OF INDOOR AIR POLLUTION
Affected Household Members initials: ____ ____ ____ ____ ____
Dust on furniture / Visible in air
House odors
Allergies
Asthma
Sinus problems
Headaches
Sleeplessness / Light sleeper
Snoring
Sore throats / Colds / Flu
Itchy/ Watery eyes
Coughing / Throat clearing
Lack of Concentration
Depression / Irritability
Fatigue / Naps
Mold / Mildew in basement & bathrooms
Pet dander and odors
Smoking
Wood / Coal heater
Static Electricity

As you fill this in and realize how much is affected by your indoor air; maybe you should try an ionizing/ozone air purifier like I have.  It's removed all respiratory ills in our family with 8 children 19 down to two. I know breathing in that purified air night after night in and out, in and out has healed our lungs and even strengthened our immunes systems.  My air purifier is no medical machine, but it's sure amazing how good you can feel breathing in purified air that's cleaned like fresh air outdoors.