My daughter is almost 3. We took her to a pediatric pulmonologist early in the summer for suspected allergies, as we see cold like symptoms seasonally. (The same as my husband whose #1 allergy is grass.) They did a blood draw for allergy testing, which came back negative to all pollens, dust, and mold. Only positives were dog, cat and beef. The dr. diagnosed asthma. (She's never had any wheezing.) Our otherwise healthy daughter was put on a daily dose of Rhinocort in the morning and Singulair and Zyrtec at night. When she developed a lingering cold, we added Pulmicort (twice a day) and Albuterol (as needed). Currently, my daughter is having problems sleeping. One night she was up until 12:30. My questions:
1-Is this much medication the normal regulation for a 2 year old? I've discontinued the Albuterol, because the restlessness started the day that we started it, but the restlessness continues. Could it be some of the other meds?
2-I've since been told by others that a blood draw is not an accurate test for toddlers, specifically it does not reflect pollen allergies in youngsters.
3-She's more tired and irritable since beginning the meds. Why does she seem worse, when the meds are supposed to help her?
First off, wheezing does not always need to be present to have asthma. Conversely, all that wheezes may not be asthma. The blood draw allergy testing (RAST testing) can show some allergies, yes, but my opinion is the scratch testing is much better. Harder to do on a such a young child, but my brother had it done when he was nine months old, so it is possible...Also, if you're worried about the diagnosis of asthma, you said that you took your child to a pulmonologist? This is a lung specialist and (s)he would know, I would think, about asthma. Unfortunately, asthma can sometimes take a while to get in check, and when my asthma is out of control I sleep horribly. Albuterol does have some of the side effects of making one jittery and restless. Zyrtec is an allergy med and rhinocort is for rhinitis. Singulair is the safest med for asthma for kids. Unfortunately, it will only work for about half the asthma population. Next, they have her on pulmicort, which is also standard procedure. This will reduce the inflammation that is in her lungs. The albuterol is for prn (as needed) only. This is to open her up when she can't breathe. Logically, all these meds make sense, if they make sense to you. You know her best, so if you question the diagnosis and the medication, find a different doctor!
The RAST test is a less sensitive allergy test than the scratch test, but it also doesn't hurt as much and is less traumatic to a youngster, and for most parents, that's all they care about.
Rhinocort in the morning and Singulair and Zyrtec at night sounds fine. The rhinocort is a steroid to try to calm down the nasal allergy symptoms (like the runny nose and sneezing) and the zyrtec is an all-around antihistamine like Claritin or Allegra. It's nice and convenient since it comes in a one-a-day dosing and since it doesn't put you to sleep like Benadryl can. The Singulair is for the asthma -- it's kind of like another style of antihistamine, except it blocks another histamine-like chemical known to be a problem in a lot of people with asthma and seasonal allergies. It is kind of hit-and-miss as to whether it'll help asthma or not for some people but it's for sure worth a try, especially considering how safe it is when compared to a lot of other drugs.
As for her never having had any wheezing, that's not a definitive test saying for sure she's not asthmatic -- a lot of younger kids won't wheeze until they're much older, and conversely, wheezing in a young child doesn't necessarily mean asthma either, since their airways are so small that any tiny constriction (including a little bit of snot) can sound like a wheeze. The real test will be pulmonary function testing as soon as she's old enough to accurately follow instructions (say like, age 5 or 6.)
The Pulmicort calms down the inflammation inside her lungs and can keep the coughing and secretions she's coughing up from becoming a problem. It's also not a drug that works quickly -- it can take up to two weeks of taking it daily for it to take its full effect. Ask your doctor if perhaps she should not be on it every day, symptoms or not. That's how most adults are managed.
The albuterol is a rescue drug. It'll open up her airways and let her cough out what's down there and help make it easier for her to breathe. It will make her a bit restless but it shouldn't be too much of a problem. You might also find that her feeling sick in the chest will make her restless and irritable more than the drugs will. Being able to breathe comfortably might relax her more than not giving her a sympathomimetic drug might.
You should also never discontinue a drug without telling her doctor that you're discontinuing the drug. Some drugs need to be tapered off, and other drugs you might be doing more harm than good.
I to have a 3year old diagnosed with Asthma. My child is on Singulair every night and Zyrtec in the am. The Singulair does make him very sleepy, but since beginning on it: his bouts of the non-stop coughing have stopped. He didn't wheeze either, I was kinda surprised when they diagnosed him with asthma. I was concerned with his coughing every morning and night, he would wake coughing and most of the time throw-up and again in the am. He was tested @ age 10months for allergies which he does have, along with some foods (that is initially why he was tested, he received the the skin ***** testing, which @ 10months was awful!!!!! but since, meds he is not at all sick like he use to be. Maybe is was worth it? ... But-is their an actual "test" for Asthma?? They just said he had it, I guess from what I was telling about the coughing, when sleeping and at play (when he is really running) and when he did get a cold it was instantly in his chest, is that enough to diagnose? How was anyone else diagnosed?
Thanks!
[This message has been edited by badkat (edited 10-23-2003).]
The golden standard to diagnose asthma is a bronchial provocation (methacholine challenge test). To be able to do this, one must be able to produce an accurate spirometry, meaning (s)he MUST be at least 5 or so. What this does is they measure your lung functions with a spiro, and then they administer a drug that is an irritant to asthmatics. (usually methacholine, hence the name) The first dose they administer is very small. Then, they take another spiro. If your lung functions have dropped 20% (I think that is the number...almost positive) on the first dose it is determined that your lungs are very twitchy and your asthma is more severe. The test is stopped and a bronchodilator is administered to reverse the effects of the methacholine. If you do not respond, they proceed forward like so until you do or until they've reached eight different concentrations. Then it is determined that asthma is not so likely.
Asthma in a 3 year old 
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