My two year old daughter has asthma that seems to be triggered by respiratory infections. She has been in the Emergency Room two times in two months with rapid/noisy breathing that required hour-long albuterol treatments and oral prednisone. A specialist has recommended we give her Pulmicort once a day throughout the winter. Beyond the common side effects of dry mouth and thrush, I am hearing rumors that Pulmicort can cause strange behavioral side effects in children. (irritability, mood swings, and mania) I would like to try the Pulmicort-I don't want her to end up in the ER every time she gets a runny nose this winter. I realize albuterol and oral prednisone have serious side effects, too. Any advice? Any stories? Thanks!

Hello, My daughter is 2 , and has asthma to! Shes been hospitalized 3 times, last time she was in intensive care. They just put her on Pulmicort last month and so far so good!! She seems to be doing very well with it. We rinse her mouth out and wash her face after every treatment. She doesnt seem to have any side effects.

I know prednisone is a life saver when you need it but the side effects are horrible , shes a different person when shes on prednisone. almost like jeckel and hyde.

The first thing I would suggest is allergy testing to see if her trigger can be determined. I too thought my daughters asthma was caused by the common cold that all children love to share since that was the only time she had a flare. Turned out to be an allergy to dust mites that just worsened when she had a cold. Anyway, we had the allergy testing done and immediately minimized her exposure as much as possible to the mites and put her on pulmicort at the same time. She has been on the nebulizer and now the flexhaler with no noticeable side effects whatsoever. She also has not had an asthma flare in months, and they used to occur weekly. I was very frightened about starting the pulmicort, but I can't tell you what a relief it is to hear her breathing normally again without the weekly trips to the Dr or ER. She often did not respond well or at all to albuterol and would end up in the ER.

I haven't heard about behavioral problems associated with pulmicort prior to your post, but I have not noticed any changes in my daughter except that she is much more active now that she can breath easier. That's a good thing.

Hope your little one is doing better!

Thank you so much for the replies. It is good to hear positive stories about this drug. My daughter has been tested for allergies and all came back negative. I have a hard time giving her a drug every day for something that only affects her once every couple of months. My husband and I have decided to give her the pulmicort at the first sign of a cold, the way it was originally prescribed to us back in August. (We did not follow these orders in October when she started a runny nose, and two days later she had an asthma attack that took us to the ER.) Her nose started running last week and we gave her Pulmicort for three days and we seem to have made it through a cold without an asthma attack, so I am optimisitic. Incidentally, we have also eliminated all dairy from her diet because of suspicion of a mild milk intolerance that could be affecting her lungs. (We have seen a nutritionist for advice.) I have also stopped using furniture polish and chemical cleaners in the house. I hope I am doing everything I can to prevent another attack, but it is hard to know for sure. I am still very paranoid! I have another baby coming in January and I can't imagine rushing to the ER with a newborn in one arm and a wheezing toddler in the other.

Hi,
My son is two also and was diagnosed with asthma about two months ago, although his first attack was back in june. He gets it when he's sick or running too much and has bad allergies to dogs/cats, anything outdoors, basically anything living (although we haven't done testing yet, he'll get rashes, etc.) We started pulmicort a few months back at the same time we started singulair. He has been more extreme in his behavior...like the littlest thing will set him off and he'll throw hour long screaming fits. Very difficult and I don't know if it's the singulair or pulmicort. The albuterol makes him very hyper, but not moody and when he was on albuterol, pulmicort AND prednisone he was a maniac!!! Anyway, I would try the just with a cold treatment and see how that goes for you. In the long run attitude changes are difficult, but better than a severe attack. Good luck!!!

Our 19 month old son has been on pulmicort for about 6 months. We give it to him twice a day with no side effects. The 2 asthma attacks he had previous to this landed us in the emergency room for breathing treatments of albuterol every 3 hours. A couple of days ago, he was having a dry cough and labored breathing at daycare. My wife rushed him to the emergency room where his breathing was clerened up by Xopenex (albuterol I believe) and we are continuing to administer Xopopnex every 3 to 4 hours and we have an oral steroid which he is on for the second day. His breathing is getting better, but he still appeatrs to need the albuterol. He hasn't had much of the oral steroid, but we'll see the side effects if he has any. Our son, Colton, has asthma, is prone to febrile seizures and multiple food allergies (dairy, eggs, soy and peanuts). I'm not that big of a fan of overmedicating, but what are you going to do in this cuircumstance, right?

Good luck and thank you to everyone out there posting information.

Your stories sound a lot like my 5, soon to be 6 year old son. He had his first asthma attack at the age of 28 months and was hospitalized for 3-4 days. His next hospitalization was in December 2006 a week before christmas for 2 days. He has had about 5 trips to the ER for asthmatic episodes since then. At first we noticed it seemed to be only when he had a cold but now he is showing signs of having episodes when being exposed to furry animals. He had a bad reaction to a dog once. He also has a peanut allergy and his other allergy tests at 3 years old came up negative. I plan on having him tested again in the near future. We use his flovent only when he shows signs of a cough or wheezing. He is also on ventolin during a flareup. He uses nasonex during the spring, summer and fall for seasonal allergies. All in all he is pretty managed but it definitely is frustrating and there is a delicate balance. When he is healthy and showing no symptoms the dr. prefers if he is not on the flovent so we try to keep on top of him and keep him managed.

Good luck to everyone.

My 7 yr old son has been on Pulmicort for about a year. We haven't noticed any side effects but the medicine has worked wonders. We have greatly reduced his flare ups and any colds he gets are also much shorter in length. In addition to the Pulmicort which he takes 2x a day, he takes Singulair and Zyrtec.

I did a little more looking into the behavior complaints, as I said I haven't had any problems with that. However, if you do a web search for "ask a patient," you will find a place where tons of people post their experiences with meds, and behavioral changes is a common complaint with pulmicort.

Thank you for the tip SheaUSMC. That web site scared me a little bit! My daughter certainly changed when we gave her the Pulmicort twice a day while she had a cold. For the past seven days we have given it to her once a day, and she has been normal. I still feel overwhelmed by this decision. Is her asthma serious enough to warrant a daily medication? I worry about giving it to her, and I worry about not giving it to her! She has gotten so good at using the nebulizer, though. I wonder if her two attacks last fall were so serious because we couldn't give her the albuterol effectively at home. She screamed and thrashed and barely got any into her lungs! I never thought I'd be such an indecisive parent!

I can't speak directly to whether pulmicort has side effects for toddlers but had two thoughts - first of all, there are lots of opinions based on personal experience posted online that may or may not be directly tied to those medications so don't get too freaked out (for some reason it looks like the negatives outweigh the positives by about 10:1 even though I took pulmicort for several years with no side effects).

The second thought is that if your daughter is having to use a nebulizer regularly getting her on pulmicort (or another inhaled steroid) is definitely worthwhile - nebulizers are great for short-term severe asthma flare ups but can pose lots of challenges for long-term chronic asthma that inhaled steroids can really help with.

You are right about the personal stories. I have to remind myself that these people have all kinds of health histories and other variables that need to be taken into account! Could I trouble you to explain what you meant about the nebulizer comment? Do you think that using a nebulizer is better for rescue meds than for daily steroid delivery? Our specialist implied that because my daughter is two, a nebulizer is the only effective way to administer the Albuterol or the Pulmicort. We have an inhaler with a spacer for emergencies on the go, but we have never tried it.

My comment about the nebulizer wasn't because it's not an effective means of delivering the medication (they're great, particularly for a 2-year-old).

The challenge with a nebulizer is just the inconvenience of using one, so getting her on a regular maintenance program (when she's old enough) that doesn't require her to use a nebulizer, even it means 2x a day of pulmicort (using the spacer) will make life easier for you and her.

Typically only patients with the most severe forms of asthma use nebulizers regularly (or others when they have a severe flare up), so when she gets to a place where her asthma can be managed using the inhalers you'll have one less thing to worry about.

I would assume the dosage of Pulmicort (same number of X's daily, same amount) would remain the same whether you are using a nebulizer or inhaler to deliver it. Some studies show that children especially, receive more of the medication to their lungs with a nebulizer than with the inhaler, even with a spacer. As the other poster stated, convenience would be the main reason for changing the delivery method. (although side effects, too, can vary according to the delivery method)

As for the comments listed online in regards to pulmicort, I should have noted that most people don't go online to praise such meds, they go out there in search of information because of problems they have had with it, so obviously when reading sites like the one I referenced below, you are going to see the negatives outweigh the positives. I simply wanted to show that according to many patients using this med, behavioral changes are apparently a problem for some people. I think it is important to look for side effects to meds that the drug companies don't list. The last time I checked, behavioral changes were not listed as a side effect of Pulmicort, but it would appear that it IS a disturbing side effect for many people. I would however, assume that they are in the minority.

Violetsmom,
I haven't read the other posts, but here's my story. The same thing happened with my two year old. He was finally put on Pulmicort which has helped TREMENDOUSLY. His most recent cold I did not have to use any albuterol or prednisone, thank God!! The only thing is that at first they had him on the 50mg. of Pulmicort once a day and he was a maniac...much like the behavior he had when on the Prednisone...highly emotional, hour long screaming fits, nothing could calm him down. The new allergist lowered him to 25mg once a day and immediately he went back to being his normal fun loving self. So, I would deffinitly give it a try, but know that dosages may have to be adjusted (obviously depending on how well your child does breathing). We have barely had to use albuterol (which makes him crazy hyper) since being on pulmicort for about 3 months. Before Pulmicort, he was having several attacks weekly, and every time he got sick it would be a week of breathing trouble.
I know how encredibly difficult the decision is, but I think it's worth a try!!

About the nebulizer...our specialists agreed that it is the most effective way to get the medicine in. I feel better using it, because I KNOW that the medicine is getting into his lungs. We have our child on a routine where he watches a special video and takes his "fishy" medicine through the nebulizer. We do Pulmicort daily, and if ever needed, the albuterol through the nebulizer. Of course you would want to carry your inhaler everywhere for on the go and they do have a liquid form of albuterol "just in case" you're on the go and are not sure if the inhaler worked properly for the child...albeit, the liquid form amplifies side effects (hyperness for us), but I'd rather have that than not breathing!

I too am questioning the use of pulmicort and just discovered the website askapatient.com where numerous posts are given regarding the emotional side effects that parents have observed in their children under 5 years of age. My son is 2.5 yrs and this is his second season on pulmicort. I give it to him via nebulizer once a day throughout the winter flu season. If he does get sick, then we up the dose to twice a day. He tends to get his asthma attacks when he gets sick with a respitory illness. I have done several searches on pulmicort side effects and emotional changes is listed as a less common side effect. While this drug has dramatically improved my son's breathing, he tends to suffer from difficulty sleeping. He has a hard time getting to sleep and is often up until 10:30 or 11:00 p.m. trying to get to sleep, but unable. He has trouble with diarrhea which is a listed side effect. I also think he is more moody and has a very light appetite as a result of the drug. I am looking forward to getting off the drug in March and spending time this summer trying some alternative treatments. I have heard that asthma patients have great success with homeopathic remedies and alternative medicines that boost their immune system.

It sounds like you might need to talk to the doctor about tweaking your son's dosage a bit to see if his difficulty sleeping can be improved - it's very common to have to adjust the dosage, particularly once he's been on it long enough for the medication to have an affect.

Beyond that, keep in mind that people are much more likely to post about their negative experiences than the positive ones (when they don't have any side effects or problems they don't think twice about the meds they're taking).

Second, please be cautious - for example the claim that Respitrol can increase peak flow readings by 400% is beyond ridiculous. For an average (non-asthmatic) adult, standard peak flow readings are in the 350 - 500 LPM range - if someone's peak flow readings was enough to achieve a 400% increase (i.e. they started at 100), you would be in respiratory distress and probably hospitalized on oxygen.

There may be some legitimate alternative therapies out there but be careful.

My son is 3 and he was diagnosed with asthma a little over a month ago due to his chronic/seasonal cough. The pediatritian prescribed the nebulizer twice daily with the Albuterol and Pulmicort combination but I don't recall her giving us a time frame with it. Shortly after the diagnosis, we took him to the ER for high fever, coughing and other server cold simptoms. He had early pneumonia, so we continued the nebulizer plus the antibiotics for 2 weeks then stopped. He was fine until 2 weeks later he had the same simptoms, but this time he had full blown pneumonia. Again we've been doing the nebulizer plus antibiotic and we are nearing the end of the second week. He seems back to normal and I really want to discontinue the nebulizer because I'm not even confident of the initial asthma diagnosis and I don't think he needs to be on this medication daily if he is not sick. Due to an insurance change, we currently don't see his previous pediatritian nor have we found a good one that accepts the new insurance. Does anyone have any suggestions? Thanks so much!

It can be tough for docs to diagnose asthma in kids that young but it's probably not a good idea to stop the meds without the supervision of a doctor - particularly if he's had two bouts of pneumonia in the last couple of months (that's pretty unusual). I think you'd be better off finding a new pediatrician (or a pediatric pulmonologist) before you stop the meds on your own.

I would suggest seeing an asthma/allergy specialist like we did with our toddler. (Your child's chronic cough could even be allergies. Was he tested?) He couldn't really tell us if our daughter has asthma or not, but he gave us an asthma action plan. Our pediatricians aren't very familiar with all of the meds and symptoms associated with asthma. Our two year old had pneumonia followed by severe bronchiolitis two months later. (Both times serious enough for an ER visit and 5 days of prednisone.) But I understand it is hard to continue with the nebulizer if your child doesn't have daily symptoms. I have to say that I totally recommend using the Pulmicort the way that my daughter was prescribed it. It has been over four months now since her last asthma attack. She has had a few serious colds this winter that went away on their own. We simply give her the Pulmicort as soon as we see a cold symptom and stop using it when the cold goes away. I am learning that most pediatricians don't believe in this method, but our specialist is all for it. Now that winter is almost over, I am all for it, too!

Hi,

There are overwhelming complaints out there about Pulmicort. I just printed out 10 pages of complaints from www.askpatient.com which I'm going to use for our next doctor's appointment. I want my son taken off Pulmicort right away! He is four and has been on it since he was 6 months old and the older he gets the more significant the behavioral changes we notice when he's on it -- irritability, sleeplessness, and aggressive and downright mean, especially with his teachers and classmates at preschool! We didn't know what was causing the problems except that his teacher noticed the behavior went in spurts and we started taking note of what he ate or where he went everyday. And that's when we realized it was when he was on the Pulmicort for at least 3 days and he became a completely different child--disobedient, hitting, kicking and just operating in a world of his own. He would also lose his train of thought fairly frequently when he's on the Pulmicort. When off the Pulmicort after about 2 days, he's back to being a sweet kid! I totally regret putting my son on it as we have put him through all kinds of behavioral tests and the counselors/social workers were baffled because they couldn't find anything wrong with him. Of course they visited when he wasn't on Pulmicort. But now by process of elimination, we realize that there's nothing wrong with him but everything wrong with Pulmicort! Good luck!

Jenna-

Your son may very well be experiencing side effects from pulmicort so it's certainly worth talking to your doctor about but please keep in mind that the online comments posted about every medication - including pulmicort - are overwhelmingly negative because most people take the meds with no side effects or problems and have no reason to post anything. I've looked up the meds I take everyday for my asthma (singulair, flovent & rhinocort) and they all have terrible ratings even though I've never had any issues with any of them.

Pulmicort has been on the market since 1982 (longer than any other inhaled steroid) and is used by millions of people every day - the website you mention has a total of 66 ratings.

Again, if you think your son is having a reaction you're absolutely right to talk to your doctor about changing his medications, but please keep the complaints you find online in perspective.