Hi all!

My daughter was just diagnosed with asthma, but I'm not sure what that means for us in the future. We can't really figure out triggers for her, she just coughs a lot and is very prone to URI's, Pneumonia and bronchitis infections. Has anyone else been diagnosed as an infant or has a child who was diagnosed as an infant who can give me any insight as to her future? She is seeing a Pediatric Pulmonologist and is starting on Albuterol? with a nebulizer 3 times per day.

Thanks for any insight!

Rhonda

The good news about childhood asthma is that your daughter is more likely to grow out of it. The airways of small children are narrower than in adults and they will grow as the child ages. Of course, this isn't true for everyone - your daughter may have asthma into adulthood as well.

If I were you, I'd take her to an allergist as well as the pulmonologist to investigate the possibility of allergies as triggers. If she is found to have many allergies, it would be a good idea for her to stay with the allergist since they often have more experience in treating asthma. But if she's found not to be an allergic asthmatic, you could stick with the pulmonologist.

Since she's prone to respiratory infections, the pulmonologist may get a sweat test done for her to rule out cystic fibrosis, a genetic lung and gastrointestinal (stomach) disease. But again, I'd suggest taking her to an allergist first to identify what, if any, allergens exacerbate her asthma.

You've asked about her future, but to tell the truth, no one on here can accurately predict what the future will bring. Asthma in childhood tends to be a bit more severe, so you may want to be prepared for ER visits and possible hospital admissions. As she gets older, say 10-12 years old, there are many paths her asthma could take. It could go away completely and you'll never hear another wheeze again, or it may become more severe. Another thing it could do is make you think that it went away, but may resurface later in life.

Oh, and albuterol is an asthma "rescue medication". It works by relaxing the muscles that surround the airways that get tight during an attack.

I hope that all made sense. :p I wish you and your daughter the very best of luck in the future. :)

The most crucial piece is to find out what her triggers are. I absolutely agree that you should get an allergy test. At such a young age, a skin test would be more difficult on your daughter than an IgE test, which is done with a blood sample. Ask your pediatric pulmonologist if he/she can run that test or if he/she can refer you to a competent pediatric allergist.

The younger the child, the better off they are getting medication by a nebulizer. It's easier on them and you and you can be sure the medication is getting to the lungs.

I was diagnosed with severe allergic asthma at three years old. That was 33 years ago. The good news is that there are a number of companies working on some new avenues of therapy for asthmatics and there is hope for all of us.

I wish you and your daughter the best.

Thank you both for taking the time to respond to my message. We had seen an allergist/immunologist a few months ago, but only tested her immune system. He never suggested testing her for allergies. I will give him a call and see what he says!

Thanks again!

Please let us know what you find out and how you're daughter's doing.

Well, we had a sweat chloride test today and it was negative!

That is definitely news to celebrate! I am very confused, though, about her condition. I was off work for 2 weeks with her and she seemed to be doing a lot better. She was still coughing every day, but her chest wasn't nearly as congested as usual. Since being back at daycare for a week, she has gotten really bad...bronchitis for sure with a constant runny nose...and it usually turns into pneumonia before long. She is having her "productive" coughing fits with at the most a few minutes between. She is also making this grunting sound at the begining and end of her fits. The albuterol does not seem to make a difference...in fact sometimes I almost think it makes her more rattlely in the chest. (I think I just made that word up, but hopefully you get the idea!) Should I contact her doctor about this? I'm afraid they will just put her on more antibiotics...she's been on 6 rounds already. Is there any way to control her coughing?

Thanks again for being here for me...I don't know who else to ask!

Oh! I have spoken with the allergist and am waiting on a referral to go back to see him.

Well, we had a sweat chloride test today and it was negative!

That is definitely news to celebrate! I am very confused, though, about her condition. I was off work for 2 weeks with her and she seemed to be doing a lot better. She was still coughing every day, but her chest wasn't nearly as congested as usual. Since being back at daycare for a week, she has gotten really bad...bronchitis for sure with a constant runny nose...and it usually turns into pneumonia before long. She is having her "productive" coughing fits with at the most a few minutes between. She is also making this grunting sound at the begining and end of her fits. The albuterol does not seem to make a difference...in fact sometimes I almost think it makes her more rattlely in the chest. (I think I just made that word up, but hopefully you get the idea!) Should I contact her doctor about this? I'm afraid they will just put her on more antibiotics...she's been on 6 rounds already. Is there any way to control her coughing?

Thanks again for being here for me...I don't know who else to ask!

Oh! I have spoken with the allergist and am waiting on a referral to go back to see him.

So glad to hear that the sweat test was negative. :)

If she's an allergic asthmatic, it's possible that the daycare has allergens - mold, plants, and animals are all possibilities. We'll just wait for the results of her allergy testing though. I've heard before that it's normal for a baby to get sick a lot at daycare because their immune systems aren't quite developed yet. Is it at all possible for her to stay with a relative while you're at work?

The grunting noise at the end of her coughing fits means she's having trouble breathing. When you hear that grunting, prepare the albuterol. The albuterol should help, but yes, it will make her more "rattly" because it opens up the airways, thins out the mucus a little, and allows her to cough more effectively. You should still get the doctor's opinion on it though. I'm wondering if small children can be put on oral steroids for a short time to get the inflammation under control.

When she's a little bit older, if she's still having bad asthma attacks, ask the pulmonologist about starting her on some low dose Pulmicort - it's an inhaled, nebulized steroid and is by far the safest one for kids.

There's not really a way to control her coughing, because you really don't want to supress an asthmatic cough unless it's dry and disruptive, but even then, you have to be careful. Supressing a productive cough is just going to clog her up more and possibly cause pneumonia.

This must be terrible for both of you, with your child being so sick, and you watching her be sick. Good luck with everything, I hope it all goes well. Take care. :)

Well, we had a scary week. My daughter was getting so bad that the Pulmonologist wanted her to go to the hospital. We ended up getting her under control with the Albuterol, but we had to give her a lot! She is doing much better now, but our Doc has now prescribed Pulmicort (just like you said, Rachel!) We need to continue on the Albuterol at the same time as the Pulmicort until Friday and then can try to take her off the Albuterol. He thinks the steroids should be more effective at treating her cough. It's a little scary to read the warnings for Pulmicort, though. Anyone been through this particular treatment long-term? Does it really affect their growth?

Sorry for all of these questions, but we have no one else in our family with Asthma, so I have no one to bug except for the Doc and he is really busy. (Although, I am impressed that he called me today - Saturday - to tell me to switch the meds.)

Thanks!
Rhonda

Sorry you had such a bad week. That sounds really scary. Pulmicort should help to get her asthma under better control, though.

I believe if taken long term, inhaled steroids may stunt growth, but when the child is taken off the medication, they will catch up. Pulmicort is the safest and least potent of all of the inhaled steroids out there. Keep her on it until the doctor says to stop. I think you'll be impressed with the results you'll see.

The type of steroids that you want to watch out for are the ones in tablet form taken by mouth (prednisone, Orapred, etc.) These are the ones that cause the bad side effects like the puffy face, diabetes, osteoporosis, adrenal insufficiency and more. This type of medication is only used during an asthma flare-up or if inhaled steroids aren't doing their job.

Don't be sorry for the questions. That's what this board is here for. :)
Take care.

Hi again.

We are doing the Albuterol 3 times/day as well as 0.5mg Pulmicort 2 times/day. Faith has not been wanting to eat solids for the past 3 days. She will still take her bottle, but is refusing cereal, jarred food and finger food. She also has been vomitting a little and blew out her diaper tonight. I have been looking for side effect information on the Pulmicort, but nowhere does it list these side effects. Could someone please tell me if this is normal, or if I should call her doc. I hate to bother the Pulmonologist, but I have no faith in her regular doc. (Plus, they told me that they would prefer if we talked to her specialist instead, since they don't really know how to treat her.)

Thanks for any input!
Rhonda

Hi,

I'm not so sure that it's the Pulmicort that's making her lose her appetite, but it may be related to the albuterol usage. There have been theories that albuterol, in addition to relaxing the airways, also relaxes the lower esophageal sphincter (LES). When the LES is relaxed, stomach acid can rise, causing acid reflux. Acid reflux disease is common in babies and young children. It's also linked to asthma - many asthmatics have acid reflux disease. In children, it's most commonly treated with Zantac, though I'm sure there are other ways of treating it.

Stomach acid can also be an asthma trigger and can cause bronchitis and pneumonia through aspiration. When she sleeps, she can be refluxing and inhaling the acid into her lungs, causing irritation and thus, asthma. Many times, when the reflux is treated, the asthma goes away because that irritant isn't there.

However, asthma can also cause acid reflux. The lungs of an asthmatic are hyperinflated during an attack due to the inability to expel air properly. The lungs then press on the stomach and cause acid to rise up. In this case, treating the asthma can get rid of the acid reflux.

I've got some other ideas regarding whether or not it really is asthma since she's very prone to lung infections and could possibly have acid reflux, but I won't get into them right now.

Anyway, I'd suggest taking her to her pediatrician for now and seeing what he thinks. It may not even be acid reflux, it could be a little stomach bug or something that'll pass on it's own. (anything going around in daycare?) If her symptoms persist for a while though, it's more likely to be reflux. (Geez, I must've said acid reflux twenty times in this post! :p) I hope she gets feeling better soon.