Question:
I have a 5.5yo daughter who has asthma attacks when she gets a cold/flu.
This started when she was 2yo and we have a nebulizer at home. We use
that with the albuterol and it's been working great until this flu
season.
Back in Oct '96, she had bronchitis/bronchospasm and the albuterol home
treatment wasn't helping at all. The doctor prescribed prelone and it
was the first time she had it. It worked great and she only needed 3
days (1.33 tsp/day) of it. Since Oct, she had been in similar
situations in Nov, Jan and Mar where the albuterol home treatments failed and
prelone did the magic trick.
I have several questions:
1) Why does the albuterol nebulizer home treatment stopped being
effective? Is she "getting used" to the medication? Or is
her asthma getting worse?
2) Can we use something else other than albuterol with the nebulizer?
3) Since prelone is a steroid, I'm concern about her chronic need
of it. Should I be? What's the side effects for long term use?
4) Since I know the albuterol nebulizer alone will not work anymore,
I asked the pediatrician about having some prelone "standby" at
home. His comment was "If you need that, then maybe it's time
to start her on the maintenance program where she'll take 2 puffs
of anit-inflammatory daily." He seems to imply that the prelone
equivalent in an inhalor form has less side effects than the oral
kind. Is that true?
5) I hate the idea of putting her on any medication when she is not
ill.
She is perfectly healthy in between her asthma attacks which are
always brought on by some kind of virus/bug. Lately, her attacks
has been every couple months. By starting her on the daily program,
are we getting her into depending on these drugs the rest of her
life? Her pediatrician said we'll need to do it for 6 months then
she can get off and stay off it if she has no more attacks. What
is the odds of that? I don't want to start her unnecessaryly and
have her body "get used" to more medication.
Any info or anecdote?
Answer:
First, your nebulizer home treatment has NOT stopped being effective,
but the way you are currently using it is probably not the best
treatment regimine. You should see a specialist. There are many
things in addition to the Albuterol that can be used to help prevent
as well as treat asthma attacks.
See first answer. Yes, Intal is one popular choice to be used as a
*preventative*. Another for use with active symptoms is Atrovent.
You don't say what type of regimine your daughter gets.
Does she do nebs daily? Is she using a peak flow meter? Is she
getting other meds to treat her allergies?
You have good reason to be concerned. When it is OVER used, it can
cause problems. HOWEVER, weigh the choices: not breathing is not an
option. Prelone in short bursts is not going to do much, if any, damage.
The side effects over a longer treatment (7-12 days) I have seen are
increased appetite, increased irritability, weight gain, sleeplessness,
hyperactivity, swelling. These are still pretty innocous in comparison
with my daughter not being able to breathe. Long term effects on a
child with a LARGE amount of prelone can include retarding their
growth. I've been concerned about this one since my daughter is way
below the growth charts now.
but the inhaled steroids still can have some effect
if given in large enough quantities. My daughter increases hers when
her symptoms are active and I see an increase in hyperactivity and
irritability.
HOWEVER, YOU NEED TO TAKE YOUR DAUGHTER TO A SPECIALIST! I'm shouting
deliberately, because it is important! You will feel better and get
all your questions answered if you go to someone who specializes in
asthma and who knows the latest treatments. New meds and guidelines
come out all the time. My daughter does the inhaled steroids, both
through the inhaler and also through a nasal spray. She is on a daily
regimine that KEEPS HER WELL. She usually only gets an asthma attack
when she gets sick from an upper-respiratory infection. We do
peak flow tests on her daily to see what her lung capacity is. I know
when to increase her meds and when to head for the doctor based on
these readings. I control her meds most of the time now, and I only
call the doctor when I can't get her peak flow levels in the right
range. Her doctor and I work together to find what works.
I NEVER would give Prelone without the doctor knowing about it,
though. Although I don't think you have given your daughter too much,
it is so important to pay attention to the instructions for tapering
off use of this drug.
I'll try not to rant, but you need to understand something. Your
daughter has asthma all the time. It does NOT come and go. She may
not have active symptoms all the time, just as my daughter does not.
Just because nothing has "triggered" an attack, the asthma has not
gone away. Asthma is a -condition- that causes the lungs to overreact
to stimulation from allergies, infections, or exercise, or any
combination of the three. The condition exists even if none of the
triggers are present. My daughter appears to be triggered by
infections. She has some allergies, however, that may weaken her
system and make it easier for her to get infections. The infections
trigger the asthma. To make sure we don't have to make ER visits
every time someone around her has a cold, we do daily medications
to PREVENT a problem. She was on antibiotics for over two years
straight. Now she is off of those, but we do a product called Serevent,
a long-acting bronchodilator, twice a day. She also uses Flovent,
an inhaled steroid. To counteract the allergies, she takes Claritin
and uses Flonase. This sounds like a lot, but it really is little
compared to what you have to do when she goes into a full-fledged
attack. We do our peak-flow meter at least once a day to find out
how she is doing currently. If she blows over 230, we stick to our
daily routine. If it drops below 230, we add a medication, and life
goes on. If it drops below 180, we start doing nebulizer treatments
every 4 hours with proventil and atrovent, and we take peak flows
several times a day. If the peak flow drops below 130, we head
for the ER. This plan give us control. It sounds complicated, but
our specialist gives us a print out that I carry with me. I even
reduced it so I could keep a copy in my wallet. I make copies for
the school and her grandmother, as well.
No one knows that my daughter has asthma this badly. She does very
well, and has missed relatively little school. She has NEVER been
hospitalized. Several of her friends who are being treated
more casually have been hospitalized, and their mothers still act
as though they don't really have asthma that bad. My goal is to
keep my child out of the hospital anyway I can. If she gets that bad,
it won't because I haven't fought to keep her well. Sometimes I've
given her nebulizer treatments every 2 hours around the clock. Not
my idea of fun, but she stayed home from the hospital.
Please, take this seriously, and don't worry about the number of
meds she takes, worry more about makins sure she gets the right ones
and that a doctor who really understands asthma treats her. I've
seen too many friend's kids who are undertreated and suffering for it.
This condition can be controlled, but it can also be fatal if it
is not managed well.
I don't want to imply that you have a bad pediatrician; on the contrary,
the treatments he has prescribed are pretty usual. The difference
between him and my specialist is that my daughter's asthma doctor
is working constantly on preventing the problems, not just treating
the symptoms. Specialists usually know about the latest/greatest
treatments ahead of general practice doctors or pediatricians. We
see her doctor every three months just to confirm that the treatment
she is getting is still working and to decide if anything can be
dropped/added/changed. We've actually backed her off many meds she
was on when she was younger and sick so often. If she continues
to do well, she'll drop other meds eventually. If she tests
positive for allergies, we'll try to get her treated so that her
sensitivity to infections will also decrease. My daughter, who is
6, is now taking a more active roll in her treatment. She knows that
it is important to give me her best effort on her peak flow meter,
and she reminds me which meds to give her next! ;) She doesn't feel
like an invalid, because she does everything everyone else does,
including baseball, soccer, etc. We just have to be attentive to
her condition and know what to do if she starts having trouble.
I wish you and your daughter all the best, and I hope
