Atelectasis and Peribornchial Thickening in a 3 yr old/ Normal?

[5parkerfamily]

My 3 year old was born with asthma (full term, natural/vaginal delivery).  He has pneumonia every other month (since birth), he has also had bronchiolitis (without RSV), bronchitis, H1N1, and most currently RSV.  When he was two we removed his tonsil and adenoids in hopes to help his asthma symptoms.  While it did decrease the amount of sinus infections he had, it did nothing to help any other area.
He is on Advair, 115/21 two puffs twice daily, and Allegra (for unknown allergies).
He has had countless chest xrays, as well as a CT scan of his lungs (when he was two), which showed atelectasis and peribronchial thickening.  He was recently diagnosed with RSV (tested positive) his chest xray showed more cuffing, and no improvements in the areas of atelectasis.
Is this all normal in a child with asthma?  I have friends who have children with asthma and their xrays all generally look fine.  Whereas ours do not.  Can cuffing and atelectasis cause long term damage?  How long does it take for this to clear up?  What causes scar tissue?  Is it normal to have pneumonia as frequently as he does?  I do own a pulse oximeter, which I use to closely monitor his o2 (normally he is 96 or above, several times a week he does drop to 91-95), usually in addition to other symtpoms of clamminess, shortness of breath, frequent/persistant coughing.
He is from a pet free, smoke free home.  We have a family history of asthma and allergies.

[Victoireh]

3 months seems to be an awefully long trial period for something that may not work. If he doesn't respond to treatment within 2 to 3 weeks, then I would haul your son right back in to see his specialist and ask for something else. To leave asthma out of control is not ideal and can set up the lungs for infections. I've been there, and absolutely no fun. I spent 9 months this last year with out of control asthma, it wasn't till I got a nasty lung infection which caused a severe asthma exacerbation that I finally got different inhaler treatment. Now it is much better. However I have residual affects from that infection, that I"m sure is some lung damage. In children with small airways they are more prone for damage, and that can set them up for small lungs (lower lung function) as adults.

Also try to get him tested for GERD, sinusitis and unknown allergies, as all of these things can make asthma worse and require higher amounts of steroid inhaler. If he has sinusitis then having his adenoids removed will not help much. If he has a lot of airborne allergies, then he may do well with allergy shots. These weekly shots help to desensitize his immune system to pollens/cat dander/molds and dust mites. My daughter has take these shots for a number of years and they helped reduce her allergy/asthma symptoms substantially. It is more work, but well worth it if it works well for your child.

[5parkerfamily]

Thanks for responding.  He was tested at birth for CF, it was negative.  Our pulm at Children's doesn't feel he needs a sweat test.  Our pulm is the one that seems to think this is all very normal for asthmatics.  I am frustrated mostly with him, we drive 6 hrs to spend an hr having him tell us try this and come back in three months.
Are there better questions I can ask him at our appt in May?

[Victoireh]

Hi welcome to the asthma community!

Yes you are right to question his diagnosis. Especially in someone so young. This is not typical asthma, if it is then he has very severe asthma that is difficult to control. However, I would certainly enquire about a lung condition called cystic fibrosis. It is easy to test for, by measuring the salt content on his skin due to sweat. Go to a good pulmonary specialist and ask for this test. It is non-invasive and easy to do. Plus it would rule in or out this serious condition. He could also have acquired some bronchiectasis, which is lung damage to severe lung infections. The damaged areas are good breeding grounds for bacteria, which can perpetuate more infections and more lung damage. It becomes like a vicious cycle. It is important to get a proper diagnosis, so that he can get the right treatment. With good treatment his quality of life will improve.