My 2 year old has chronic ashma, is he being over prescribed?

Question

I am a bit concerned over the medication my son is prescribed. He has terrible asthma and at the first sign of a cough or cold his consultant wants me to give him 10 puffs of his blue inhaler 4 times a day along with his usual 1 puff of brown twice a day. He also gives me a three day course of steroids for any wheezy episodes. However he tends to get 'croupy 'rather than wheezy and also my GP does not agree with his consultant.
He says the dose of blue inhaler is too large and to increase his brown to 2 twice a day (his consultant says NOT to do that!!)
I'm at a loss as no one seems to agree. He has an awfull croupy cough at the moment and has been given antibiotics. his blue inhaler is relieving him for a short while, but the effect is not long lived!
Any advice on what else I can do to help him, or why his doctors cant give me a straight answer.

Thankyou for your answers so far. Dr Frank is correct with the medication names and doses.(You really know your stuff!!) I feel a little better about giving him his meds, but would still like to hear from anyone else who cares to share. xxx

Answer 1

There are a huge number of issues here.

I can only give you my view as a GP with a paediatric background.

First blue inhaler presumably salbutamol. It should now be given using a large volume spacer with a mask, never as an inhaler into the mouth as the drug will be swallowed rather than inhaled. Ten puffs is a good dose, as most of the drug fails to get into the child's chest. One of our local Respiratory paediatricians chooses 12 puffs. It is far from critical as the safety margin is huge, One can give a 2 year old 5 mgs of nebulised salbutamol 4 hourly, this is equivalent to 50 puffs of aerosol.

Second antibiotics have no effect on the disease of asthma, it is an inflammatory condition, often triggered by viral illnesses which also cannot themselves be treated with antibiotics.

I am also going to assume that the brown inhaler is beclomethasone 50 micrograms/ dose. This is quite low, however there have been some dramatic changes in the thinking about how much advantage is gained from protective inhaled steroids against their possible disadvantages. Doses used have fallen dramatically. The dose range for children is up to 400 micrograms/day but this takes into account children up to 12 years. A few years ago doses up to 2000 were being used.

Most treatment plans include giving a short course of steroids at the onset of a cold, usually 3x5mgs/ day for 3-5 days.

It does seem to me therefore that your consultants management is very much in line with the most up to date guidance. Unfortunately despite this your child still gets distressing symptoms. Hopefully you are going to see the consultant again soon and you can discuss any other possible options. I note for example he is not on a drug called Singulair, this can be added to his current regime and is very successful in some child asthmatics, It is not a steroid.

Answer 2

you said his cough sounded croupy, are you sure it is not croup?
Try giving him a drink of something warm and go sit in a steamy room(run the shower with the door and window shut tight) If his cough eases up it could be croup rather than asthma. my elven yr old has severe asthma and he has to take his inhaler 3 puffs every 4 hours. His pulmonologist said if he needed more than 3 puffs to relive an attack to repeat in 20 min and wait 5 if no relief to go to an emergency room to get a shot of epinephrine. I am guessing that the brown inhaler is an inhaled steroid and should be used even when no symptoms are present. You are around your son more than anyone else and if you feel that 10 puffs is too much cut back and see if he responds to less meds. Try taking him off dairy products and see if that doesn't help some because dairy make the mucus in the lungs thicker.

Answer 3

The current evidence is that by hitting incipient asthma attacks hard and fast, your son will do better in the long run.

I can't believe you were told to give a two year old ten puffs of the reliever - I'm presuming it's Ventolin type inhaler and the brown one is a Becotide type one. Ten puffs is too high - he'll suffer more side-effects than relief.
One puff of the preventer is adequate for a two year old. He won't get added benefit from extra, and again, there are side effects.

Get rid of all fabric (especially carpet) from your son's room, if not your entire house. Have everything as easy to clean as possibe, and damp clean everything daily.

Take all sugar out of your son's diet, and encourage him to be as active within his limits - a trampoline is a great investment, and good exercise for his lungs.

If you think he's croupy, treat him for croup as well as the asthma (choose the smallest room in the house and turn it into a steam room by boiling a kettle with the lid off until the steam fills the room - may take one or two refills of the kettle). Steam will also help loosen plugs or casts of sputum.

Get your son to do lots of exercises for his lungs - blowing bubbles is a good one, or blowing tiny pieces of coloured paper around using a straw. These activities cause a little back pressure in his airways and will encourage them to open.

Good luck - I'm sure it's very worrying for you, but I would advise you to keep going back to your consultant with your concerns until you get either an answer you can be happy with, or a change of treatment you can live with.

You should also look for a second opinion with an another paediatrician.

Answer 4

Yuh them guys really over do it

Some meds are really over perscribed I did one called Xopenex in a blue inhaler, Dr told me to take 2 puffs 3 times a day I had all kinds of "side effectd" I later found a dr in SLC that was giving his patients 2 puffs a day of the same stuff. I dropped to one puff a day and was still having side effects, finally I quit.

A strong suggestion, esp because it's a child that can't tell you everything get a blood pressure cuff and monitor this child for an hour or so after giving the meds.

Some of my meds pushed my BP up to 195 over 160, some dropped my bp to 90 over 60 either point is bad.
One friend has a ruptured arota using albuterol, another had a stoke using advair

Some gal was in here that lost her baby do to these meds.

BP/pulse rate is probably the best data you can give your DR

Answer 5

my daughter was the same as your son, shes now 24 her croupy cough used to drive us to despair. the doctors always gave us conflicting advice the inhalers come in different dosages so check them.we used to put my daughter in the bathroom with the shower on and let her breathe the steam in this always helped. get rid of all airfreshners in the house open windows everyday and turn central heating off at night as the dry air seems to aggrivate the airways.with great care boil a kettle in his room before bed this will help the moisture content in his room.main thing is to keep calm as he will feel your tension the best control is to keep him relaxed

Answer 6

my son has bronchitis he has a nebulizer ask your doctor to give your son this as it really does my son really real relief from the wheezy chest or croupy chesty cough my has 10 puffs as well so that's normal.

Answer 7

Go with the consultants' advice as they are the doctors that specialise in your son's particular condition.
If you have any concerns over your sons health and feel he needs urgent attention, take him to a+e to be treated.
Explain to the consultant next time you see him/her that your gp is conflicting against their advice.