Question:
My son seems to get asthma attacks frequently, about once a month,
lasting a week each time. I try to keep the house clean, wash the
sheets and clothes with hot water, reduce the amount of processed food
we eat, etc etc. But sometimes I feel so much at my wits' end because
despite my efforts, he's still coming down with these attacks,
particularly when he catches a cold or the flu (and kids do that so
often). Not to mention that I feel a certain amount of guilt already
(I myself had been diagnosed as suffering from "asthmatic bronchitis"
when I was 18 and I get asthmatic attacks 3-5 times a year) at having,
maybe, "passed" him the disease.
How long does it take before one gets the "hang" of managing asthma?
Previously I never took any significant interest in the subject of
asthma because I only wheezed when I caught the flu. Other times I'm
fine. For years, too, doctors told me I didn't have asthma, I had
"asthmatic bronchitis", which they insisted was not asthma.
But now that my son is suffering from asthma, I'm reading all I can
about the subject, everything from treatment to prevention. What
confuses me, however, is how trained doctors, with regard to how one
should manage the disease, can differ in opinion so greatly. It
doesn't help, either, that my son has not gained weight since March
this year, and we think it's because of his asthma.
another question, does the medication my son is taking
cause personality "changes"? Ever since June, when he started his
medication, his nursery school teachers say he's been more active but
less co-operative and more aggressive. His teacher actually said "He's
like a totally different boy!"
Answer:
Asthma treatment has changed recently, your GP is out of date.
Go with the specialist. GPs don't have time to be experts in
all the different diseases they treat. Your GP should have
consulted with your specialist before prescribing a different
treatment. Its best to go direct to an asthma doctor for
moderate or severe asthma. Nebulizers are no longer necessary, MDI (metered dose inhalers) are
just as good for most patients, and more convenient, according to
new asthma guidelines. Use a spacer, like an AeroChamber.
If necessary the AeroChamber with Mask spacer could be used.
Your specialist should be able to give you an 'Action Plan'
to adjust medication if symptoms get worse, without actually
seeing him. It will be easier when your child is a little older
and use a Peak Flow Meter to measure lung capacity at home.
In the US, we use 1997 Expert Panel Report--Asthma Guidelines.
Since you are in Singapore, I suggest the GINA (Global Initiative for
Asthma) Guidelines. You can download the Doctor's Pocket Guide at
www.ginasthma.com/gina/pocket.html These guidelines were written
with input from a doctor from Singapore; W. C. Tan, MD
There is also a patients version available, to update yourself
on treatment. Also see
http://www.ama-assn.org/special/asthma/treatmnt/treatmnt.htm
Guidelines for the Diagnosis and Management of Asthma National
Asthma Education and Prevention Program Expert Panel Report II,
National Heart, Lung and Blood Institute February 1997
Asthma Management and Prevention (A Pocket Guide for Physicians
and Nurses) GINA 1995
Another inhaler to consider is Intal, not as strong as Flixotide
but less side effects. Intal has virtually no side effects and is
used for mild asthma. Atrovent probably not appropriate, in the
US it is usually used for COPD rather than asthma.
I'm not completely happy with the high Ventolin use. 3 puffs Ventolin every
4 hr seems like a lot for 2 weeks, Hopefully this drug use will reduce down after
he gets over the exacerbation. If you learn more about asthma, how to recognize
symptoms, and use a peak flow meter, you should be able to start adjusting
the dose of asthma drugs yourself. A Pediatric peak flow meter is available, a
mini-Wright to be used at home. The new guidelines are that Ventolin should only be
use 'as needed', not on a continuous basis. The main asthma long term control
drug is an anti-inflammatory, since asthma is an inflammation of the
bronchial tubes; either Intal for mild cases, or inhaled stereoids like
Flixotide for moderate or severe asthma.
The personality change could due to better control of asthma giving him
more energy. Also Ventolin in high doses can be a stimulant.
