Baby asthma...too quick to diagnose? And other related probs!

[TheGrandOldDuke]

I was told my son had asthma at 9 months and he was given an inhaler (my thought was !!! But who am I to question?) anyway inhaler use was, as expected, not v successful, and now he is 20 months. I took him back to the dr as the first reason I was given for his wheezing was "he's a big boy" and actually, that really wasn't washing with me anymore. Makes no sense.
So they've said he is asthmatic, of an allergic type... And given him an inhaler to have 8 puffs a day of (quite a lot?!)
it's helped his asthma a bit, but he has also developed thrush in his mouth - could the inhaler have caused this? And now I've cleared up the thrush, he is complaining again of a sore mouth. Could the salbutamol be doing something?
Also....what are people's thoughts on this early asthma label? I'm not sure I know what I think yet. I hope he grows out of it....can that happen?
Any thoughts appreciated, a Worried Mummy.

[Sirzy]

What inhalers is he on? Do you know what his triggers are?

Asthma being diagnosed so young is rare, but its more common for young children to be treated as if they are asthmatic if that makes sense. Often it is a "viral induced wheeze" or similar because things aren't as developed.

DS was diagnosed with asthma at 12 months having had serious chest problems since he was 8 weeks old including a lot of day to day problems. He is 22 months now and with inhalers is pretty stable although going through a slightly worrying patch at the moment.

Have you only seen your GP? If so I would be asking for a referal to a specialist. I don't have a lot of faith in GPs when it comes to young children and there chests (probably because 2 different GPs have told me DS was fine and within 12 hours we have been in hospital!)

[EyeoftheStorm]

DS1 diagnosed with asthma at about 20 months - his was brought on with colds. He had brown and blue inhalers. Doc told me to brush his teeth after using inhalers or at least wash his mouth out with water as they can cause thrush.
DS1 is 7 now and he is growing out of it as docs said he would. Inhalers greatly reduced and rarely use the blue one.

Hope this is the case for you. It's a worry when they're so small and it took us a while to get things under control. Sometimes I forget he has it now. Hard to believe as we had some emergency runs to a&e when he was little.

[TheGrandOldDuke]

Thank you for your replies - we've certainly not been in the realms of hospital treatment for it, but he did have an operation at 6 months and had a heart scan then, at which point I asked the paediatrician about his bad chest and I ot the "big boy" comment. His bad chest is brought on by colds - he just wheezes for months after one, and I think he is allergic to his pets, so I'm moving them away until I can try to arrange allergy testing. I bet the testing is going to be a battle to get on the NHS...
He's on the blue inhaler - I am so relieved to hear that you were warned it could cause thrush - I really was worrying about what had caused it....lowered immune system etc. It's a trying time at the moment so I'm trying really hard not to panic/be overwhelmed... I just want it sorted. It's got to the point where several times a week people will say about his bad wheezing...I feel bad I've left it so long, but the paediatrician made me feel like I was being "overanxious mother" syndrome....now I think I've let my son down by not acting sooner.

[EyeoftheStorm]

No no no - my other kids get wheezy sometimes, exactly like DS1. I can't tell the difference except theirs goes away by itself whereas DS1 just gets worse and worse.
Asthma is a tough one to get a handle on. You just have to watch your son and get to know his symptoms and when he's bad and then you act. DS1 was worse when he stopped wheezing and I could just hear a grunt. As long as he was eating and playing, I knew he was ok. Listlessness was a serious sign for us.

[LilBB]

Since being little dd (3) has suffered with bad chests. Every time she gets a cold she will be wheezing for weeks. We have been told they won't diagnose asthma but she has a blue inhaler to ease it when necessary. About 1 she started with eczema and has had a few bad allergy reactions. Her whole face has swelled and she has needed steroids as she didn't respond to anti histamines. She has had allergy testing done, after the steroid treatment was needed they did it really quickly. The test didn't bring up any allergies. We are waiting for patch testing now to see if its a skin irritant.

I would say limiting time with pets to rule this out is a good idea. DD can sometimes have a flare up if around pets even though she's not allergic to them they do aggravate her chest. Don't feel bad. I started to worry I had munchausens the amount of time I spent at the GP and out of hours. Especially at the end of the allergy testing when it found none. You are doing your best and it's hard to know when to worry and when not to. You have not failed your son.

[Sirzy]

How often is he having to use the blue inhaler? If its more than a few times a week then I would be pushing for a preventer inhaler (normally brown). I have been told that when DS is well he shouldn't need the blue inahler more than twice a week which generally (now his preventer is sorted) he doesn't

[TheGrandOldDuke]

Sirzy, I've been told 2 puffs, 4 times a day!!!!!!! Seems extreme???

[Sidge]

A blue inhaler won't give him oral thrush, that is more likely with a steroid inhaler (brown or orange) and when a spacer isn't used.

Viral wheeze may not need steroid inhalers and using a salbutamol (blue ) inhaler 2 puffs 4 times a day is absolutely fine. However if he's using salbutamol that many times a day for more than a week or two, then he ought to have an inhaled steroid.

He can't really be diagnosed with asthma if he's only using a salbutamol inhaler. It's hard enough diagnosing asthma in little ones, and where they are too young to do lung function testing you tend to assume that if they have asthma symptoms that are resolved when you give asthma treatment, then it's probably asthma.

Needing salbutamol alone isn't enough to give a firm diagnosis. Does your surgery have a nurse or GP with an interest in asthma that you could see?

[Sirzy]

That in itself isn't extreme (DS has had 10 puffs 2 hourly before!) but if its over an extended period then like Sidge said the steroid inhalers would be a better option.

[TheGrandOldDuke]

I've seen the response nurse. She said she would give him the brown inhaler if I wanted, but I wasn't keen to go straight onto steroids, if the blue might work. If she'd said this was wrong though, of course I'd have done what she suggested. Did I make a mistake? We're seeing th GP tomorrow...but I don't have high hopes for any sense coming of it!

[TheGrandOldDuke]

He's been given the blue inhale on repeat, to do the 8 puffs a day.... With no further plans for review with the response nurse.

[TheGrandOldDuke]

Not response, resp!

[Sirzy]

Have a look at the asthma UK website for more details about the inhalers www.asthma.org.uk/all_about_asthma/medicines_treatments/preventer_inhalers.html

The blue reliever should be to treat the immediate symptoms whereas the preventer builds up over time and should mean the reliever isn't needed as much.

I wouldn't worry about the steroids to much, the doses are very low and unlikely to be any problem.

[Sirzy]

www.asthma.org.uk/all_about_asthma/medicines_treatments/preventer_inhalers.html working link I hope!

[Sidge]

It sounds like he would benefit from the brown inhaler if he's wheezing for weeks after a viral illness.

You can't compare the brown and the blue, they are completely different. The brown being an inhaled steroid is a preventer inhaler, it reduces inflammation, and being inhaled means it has a very local action with little systemic effect so very unlikely (in standard doses) to cause any of the problems associated with oral steroids.

The blue is a bronchodilator, so opens up the airways and can ease a tight chest, reduce shortness of breath and eliminate wheezing. It can be used as needed but the idea is that with a regular dose of inhaled steroid the airways are nice and smooth and relaxed, not inflamed, tight and twitchy, so the child doesn't get the wheezing, coughing, shortness of breath and tight-chested feeling, and so shouldn't need the blue inhaler as often.

Are you using a spacer for his inhaler? He shouldn't be getting a sore mouth from his blue inhaler.

[Northumbrian]

Concerned Grandmother time. S & DIL have been told that the bad chest in 2 yr old GD is asthma and should be treated with steroids and an inhaler. They're really worried about putting her on steroids at that age.

They think the GP just has them written off as over-worried. GP also says can't talk to paediatrician, who is abroad for several months. I'm none too confident about the PCT in their area anyway. Is this a case for going privately to one in a neighbouring area? Or are we all over-reacting.?

We're nowhere near the A&E dash yet, but DIL is a worrier and I'm new at the childhood asthma thing (tho' mildly asthmatic myself since my 30s).

[Sirzy]

If they are worried then insist on a refferal, there must be someone he can be reffered to in the local area.

However, the dose of steroids in the inhalers is pretty low and because it's inhaled it goes straight to the lungs so it is safe to use.