Hello,
Thank you for your query at DoctorSpring.com
I can understand your situation. The diagnosis appears to be ASTHMA.
The severity of your son's asthma would be probably 'Moderate
persistent' based on the fact that he has had three major
exacerbations recently.
Before we assess his response to therapy, it is necessary to ensure a
few things:
1. He should be getting SALBUTAMOL (Ventolin) /ALBUTEROL (ventolin
HFA) metered dose inhalers thrice daily for 5 days after an
exacerbation. On other days, provide the above only if he is
symptomatic. SHOULD NOT GIVE bronchodilators routinely on a daily
basis; If given it ll make him less responsive to the drugs.
2. He should be getting BUDESONIDE (Budecort/Pulmnicort) or
fluticasone (Flixotide) two puffs twice daily - inhaled steroids would
prevent exacerbation and suppress airway inflammation. THIS IS A MUST.
This therapy has to be continued and stepped up or down only under
expert medical supervision such as a pediatric asthma specialist/
pulmonologist.
3. Singular (Montelukast) may be used as an additive agent, if the
child shows poor response to steps one and two.
Based on your history, your child's asthma has been inadequately
treated and hence the control/ response to therapy cannot be assessed.
Wishing your child a speedy recovery.
Regards
Dr. Saptharishi L G
Patient replied :
Ok because we were not fully aware of the situation.
Is it reactive airway disease since none of us parents has asthma. It occurs only after flu and cold and mostly in winter as viral infections are epidemic with dusty environment.
Can we start giving Ventolin as soon as first sign of flu?
What is meant by Ventolin on as need basis?
Yes maintenance therapy started already.
We never gave Ventolin more than 4 days without doctor advice.
Hello,
Though many children with asthma have a family history of atopy, atopic dermatitis, allergy, allergic rhinitis or sinusitis, it is not always forthcoming. No viral infection would occur four times a year and each time produce bronchospasm/wheezing. Your child has an underlying airway hyper-reactivity, that is getting precipitated with a viral infection/flu ( as you have rightly pointed out). But, not every child will manifest with wheezing after every viral infection. There is no doubt regarding the diagnosis of ASTHMA in your child.
Similarly, not every flu needs to be treated with ventolin. Be aware that an exacerbation can occur and if there is any wheezing/ breathing difficulty, then you can use Ventolin.
Ventolin as needed means only when there is a breathing difficulty/ audible wheezing/ acute increase in child's symptoms - what we label as an acute asthmatic exacerbation.
Regards
Dr. Saptharishi L G
Patient replied :
Ok Thank you for the answer. I am now getting hold of all the aspects of the disease. I have stethoscope and I heard wheezing during the last episode. It is high pitched present at the end of exhaling of air. Right now he has flu , ventolin as directed by doctor for a week. I cannot hear wheezing but he dry coughs once in half hour with chest sound more likely presence of phelgm. Inhaling air also produces strong sound. He is unable to breath from nose only and keeps mouth open.
As a second opinion I want to ask about antibiotic as doctor after examining chest x ray prescribed 10 days course of antibiotics. I am not convinced as doctor was too busy in hospital. There is no fever but still i will take him to another pediatric as soon as het gets lil well.
Will he outgrow his asthma when he gets older?
Is he allergic to something as this only happened when there is flu. I agree that there is underlying hyper activity even when he is ok I can hear him breathing lil faster than normal sometimes.
So what i understood is Vintolin only when wheezing starts and preventive medicine as per doc advice.
Dear Parent,
It is wonderful that you have educated yourself to this level. Your ability to identify wheeze is commendable. However, there are so many other aspects to medical decision-making, especially in a disease like asthma, that it is very important to make the right decisions for the sake of your child's future. On the one hand, I appreciate your effort in trying to understand this disease in-depth. But, I would advise that you do not resort to taking decisions all on your own. Your decisions may be right most of the times, but we should not allow even the smallest of errors to creep in when treating a child. In fact, even among pediatricians (when my own son is unwell), we prefer to get an opinion from a learned colleague because personal whims and fancies may cloud our judgement and prove harmful to the child.
Secondly, antibiotics are not to be used rashly. I appreciate the fact that you are looking critically into it. I suggest that you stop the antibiotics if the child is not having high-grade fever or any other signs of a serious bacterial infection such as child being unwell, looking toxic/sick, throat/ear or any other focus of infection identified, etc..
You have understood my advice correctly. Take preventive medications routinely and use ventolin only when you hear wheeze on auscultation. Regarding his outgrowing asthma, only time will tell. But, many (nearly two-thirds) do outgrow their disease and hopefully, your son should fit into that group.
Regards.
Patient replied :
Thank you so much. I didn't start antibiotics because there is no fever at all and not irritated or unwell and running around playing with just mild dry coughing and lil running nose.
I appreciate your inputs and helped me a lot I think the more I educate myself the more I can care better and I am doing all this to avoid going to ER and better management at home. This disease has taken a toll on me and my wife and she feels guilty of not breastfeeding and cesearian delivery. Our other daughter while is also cesarean but continuous breastfeeding for nine months seems in better health. You have lifted my spirits. Thank you.
How can I tell that his asthma is controlled?
The asthma control depends upon his symptoms on appropriate treatment. You can monitor the following:
1. Number of night-time episodes per week
2. Number of days of missed school/ routine due to symptoms
3. Episodes of wheezing requiring unscheduled hospital visits/ ER visits
4. Number of exacerbations requiring oral/ systemic steroid therapy (prescribed by a pediatrician)
5. His appetite/ general activity and overall well being while on therapy.
6 Ability to indulge in sports and other age-appropriate play activities without symptoms
Based on such parameters and a few other parameters, we can assess whether a child is well controlled or poorly controlled. Such classifications are available on the internet. So please feel free to read up more on these topics.
Am glad that my reply was useful to you. Thank you for your generous feedback.
Wishing your child a speedy recovery.
Regards.