Possible asthma attack, how do I tell?

[adamadamum]

My DS was prescribed an asthma reliever last week as his breathing was fast and wheezy, he had a cold and cough but this breathing was not normal. The doc didn't say it was asthma, just said it couldn't be ruled out as he has eczema (not severely though). It was to be used for one week, four times a day. Don't know if her advice was correct though as she also said keep the spacer on his mouth for 5 minutes which everyone says is unneccessary.
Anyway this evening he started seeming like his breathing wasn't quite right, I asked him if he needed his "toot toot" as we call it, and he said yes. He did seem unwell. I didn't hear any wheezing though and his speech can be a little confusing at times as he is just 2 1/2. Plus I don't know if he associates his "toot toot" with feeling better - am I right to believe it isn't instant? I just want to know if he is asthmatic or not, have enough to deal with already, his sister has sn and I am on my own with them.

[JodieG1]

I have mild asthma and as a child when I used my inhaler it was pretty much an instant result. My dd has a spacer and we don't keep it on for 5 mins, ludicrous really. Enough for her to breathe it in and then off it comes. She as a brown and a blue one.

[JodieG1]

When I felt wheezy or needed my inhaler then using it meant I felt better very quickly, I think that's how they work.

[adamadamum]

Thanks Jodie, I only kept his spacer on for 6 breaths per puff (2 puffs) once I got some better info, thing is, I am trying to work out if he was having an asthma attack or not. Do you know how you can tell in a child? I am not even that sure if his breathing was laboured in any way this evening really, it was more the way he was talking reminded me of last weekend. He is a really happy boy in general, and he suddenly became weepy and clingy, and his toddler language was even harder to understand than usual. I think he may have been stopping for more breaths but it was hard to tell.

Obviously I gave him the reliever meds (forgotten the name) and by bedtime he seemed ok.
Do you think this sounds like an asthmatic child? don't worry, I am assuming you are not a doctor, I am not looking for in depth medical advice! Thanks x

[adamadamum]

Salbutamol! Finally remembered the name. I am sure you could have told me anyway.

He isn't on any 2preventer" type stuff as it isn't established that he has asthma.

[JodieG1]

You're right I'm not a doctor If he was taking more breathes that could me asthma, also can make throat itchy, chest a little tight, and I always got worse when I was running a lot or similar. If he's wheezing, having trouble breathing or itchy throat then I'd think asthma, I remember always getting worse when I was annoyed/emotional as well. The blue one should be fine for now until you establish is he has asthma or not.

[adamadamum]

Thanks Jodie! I hope it's not asthma but I think it is...time will tell I guess. Thanks again xxx

[JodieG1]

Bumping for you in case anyone else can help

[AbbyLou]

Please be aware that asthmatcis don't always wheeze! I have been asthmatic since a very young age and while I do wheeze sometimes when it's bad, I don't always and have been told that this is normal. Usually during an actual asthma attack the child will find it difficult to talk without stopping to catch their breath, they will be sucking the chest right in round the diaphragm, eyes may look wild and they will be panicky, sweaty and definitely look very distressed. The inhaler your son has should give instant relief for mild to moderate symptoms and would only be less helpful in a severe attack.
Hope he's feeling better soon!

[adamadamum]

Thanks AbbyLou, that is important information. I am concerned that I may not realise if or when he might be having an asthma attack. He is 33 months old and although he has some "terrible twos" tantrums it is only in the last couple of days that they have been really bad. He has been getting so distraught and I am trying to teach him that he can't have everything he wants, so he is getting rather upset!
I am scared the upset may lead to an attack (even though asthma hasn't actually been diagnosed, just prescribed for as a precaution) as he talks, cries, begs etc constantly when he is like this. When he is crying his breathing is naturally not at the usual pace, but so far when he has calmed down his breathing has calmed down too.

But I am worried, I don't actually even know if he is asthmatic, but obviously I don't want to neglect treating him in an attack.
also, he is a very big boy, with strength you wouldn't believe, so if he is not willing to have his spacer on it is a nightmare!

More advice welcome!...

obviously I don't want to

[adamadamum]

ignore the "obviously don't want to" bit, not always good at cutting and pasting!

[pointydog]

You won't necessarily be able to tell when he's ahving an asthma attack. If it's particularly bad you will see his stomach around ribs drawing in sharply or the hollow at top of breast bone pullingin sharply during breathing.

This must be hard for you. My dd developed asthma when she was a fully-talking child so I rely on her telling me how her breathing is feeling.

The inhaler should provide instant relief.

[bigbird2003]

It may not be asthma per se. Children can have isolated episodes of asthma like attacks from viruses. Just because it happens once or twice doesn't necessarily mean lifelong asthma

The inhaler should work within a couple of minutes. It takes 5 breaths maybe more to get the salbutamol (one squirt) out of a spacer, so whilst 5 minutes sounds a long time, if tolerated as long as possible to get maximum dose (iyswim)

Wheezing doesn't happen all the time, everytime. Laboured breathing (as described below, especially the hollow bit), pale skin, panic, being very quiet are a good sign.

IF you are worried, go A & E. A little SAT monitor (clipped on painless)is put on the finger and that will show within minutes how much oxygen is in the blood. I think 98/100% in normal, under 95% is cause for concern and under 90% will result in a night in hospital. If he is found to have low oxygen, they will pop a nebuliser on (a mask with the medicine in blown out with air) One nebuliser treatment is usually enough to put everything back how it should be. They sometimes do 2 just to make sure. Then, you get sent home with salbutamol and maybe a 3-5 day course of steroids. If they aren't concerned, it will be no big deal and the can reassure you. IME hospitals never mind where kids are concerned

One last thing, salbutamol can make children hyper and a bit shaky, so that's another thing to expect

Hope that helps x

[adamadamum]

Thanks for the advice! I am wondering though, if he is having a tantrum (and therefore breathing faster out of stress anyway), if he is having an asthma attack would he be a little weaker? I am really hoping to hear that in an attack a child is a little weaker (therefore more likely to let me put the bloody mask on!)
I have given him salbutamol a couple of times out of worry, just in case, as I am just not sure. But he is big and very strong and I am not! It hasn't been easy. So would he be weaker during an attack do you think?

[pointydog]

yes, they are weaker. When dd2 has an attack she is exhausted and has difficulty standing up and difficulty talking - cannot talk more than a couple of words at a time. The effort of breathing exhausts her.

I'm not sure how this looks in a toddler, though, and if it would make a tantrum impossible. Is there an asthma nurse at your clinic that you could talk to?

[adamadamum]

Pointydog I don't know if there is an asthma nurse at the practice, I agree it may be a good idea to speak to one if there is! To be honest I don't know when I might get round to it though as I now have a nother little health crisis in the family - one we all go through - Chickenpox! My DD has it, so expect DS will soon enough. Don't want to have any non-urgent medical appointments at the moment for obvious reasons!

One asthma question which might sound silly but what the hell, How do I tell when his Salbutamol spray is running low? Can you tell at all? I guess it is unlikely to happen for ages as we have used it just for a week (2 puffs 4 times a day) and a couple of puffs on 2 other occasions if I remember correctly. But after advice from someone on another site I "primed" his spacer with 10 puffs of it. No idea how long they last, might you be able to give me an idea? Thanks!

[pointydog]

You can hear the liquid shaking in the little canister and nothing when it's empty. Again, dd more used to all this side of it than me.

[pointydog]

by the way, you might get more advice relevant to you and toddlers if you post under Health

[coppertop]

I think that the first asthma attack can be difficult to spot until it gets more serious. With ds1 I had no idea he had asthma until I saw him on his hands and knees breathing very quickly - and I have asthma myself.

The signs I look out for with ds1 and ds2 are:

• breathing faster than usual

• shoulders going up and down as breathing becomes an effort

• paleness around the face and lips

• the skin being sucked in around the ribs (as Pointydog explained)

• lots of coughing

Being able to have a tantrum doesn't necessarily mean that a child isn't having an asthma attack IME. Ds2 had the mother of all meltdowns when I tried to get him to leave the house to go to the walk-in centre when he had his first attack. He didn't like the change to his routine. IIRC the nurse explained that the crying and screaming can actually be a good thing as it helps to force some of the air out of the lungs.

A blue (salbutamol/Ventolin) inhaler usually lasts about a month or so here but I can't remember the exact number of puffs in an inhaler. The ds'es have a minimum of 2 puffs a day so maybe around 60-100 altogether?

[adamadamum]

Thanks!