Asthma and steroids

[podsquash]

Hi,

My 4 year old son has asthma. So far we have avoided steroids. However, I think he is beginning to develop interval symptoms - breathlessness and coughing when no bug and no allergens that we know of. The clinic said that if this happened he would probably need corticosteroids.

I'm quite worried about putting him on these. I have read that it can stunt their growth and it seems like quite a big deal to me, kind of a systemic thing rather than an as-and-when thing.

So. Any thoughts?

Thanks...

Hi Podsquash - how long a course are they suggesting? DD2 has to have steroids whenever she gets a chest infection as she cannot cope with both the asthama and the infection.

I am sure there is someone more experienced than me so bumping for you.

Has your DS been tested for House Dust Mite, Spores etc? There was a thread on here recently whereby a LO was suffering from wheezing and itching at night and the poster realised the condensation on her bedroom window might be creating spores that were affecting her breathing.

Any help?

Hi Podsquash
Was your consultant talking about oral or inhaled steroids? The inhaled steroids are key in suppressing the inflammation which leads to the clinical symptoms of asthma, but are much lower doses than oral, as they are targetted directly to the affected area. In severe episodes, oral steroids will be prescribed as this is really the only way to get large enough doses into the systemic circulation to deal with the inflammation causing the bad episode.

Most consultants will avoid prescribing oral steroids because of the systemic effects. However, please bear in mind that repeated bad episodes of asthma and ill-health can also stunt a child's growth.

I am a medical scientist with an interest in repiratory disease, BTW, not a medical doctor.

Thanks for these thoughts. The clinic has suggested inhaled corticosteroids - my son has been given oral steroids on a few occasions (usually single dose) to cope with a bad attack or virus but that is not what they are suggesting this time. I'm not sure how long a course they are suggesting as I haven't really talked to them about it!

He has got a dustmite allergy as well as nuts,cats, and prob other furry creatures! So I'm well aware that all sorts of things could trigger off episodes...but so far they seemed to think it was only if his system was otherwise under threat (from a bug or a severe alergic reaction) that he would have problems. At the moment there is not much going on in terms of bugs or allergens (no more than a couple of weeks ago) so that is why I think it is 'interval symptoms'... I sort of feel like it is obvious that the inhaled steroids are necessary but I'm still scared.

If it helps, DS has been on inhaled steroids since he was 6 months old (he's now 7) - he's the tallest boy in his class and a keen rugby/football/tennis player! When the doc explained that the steroids can help prevent lung damage from asthma, which is far more likely to cause him harm than the steroids, it was a no-brainer; well for me anyway.

asthma means that your child is having DIFFICULTY BREATHING...............( and yes, thats a big deal)

asthma meds have come a long way in the last 30 plus years, and yes, long term steriods can have side effects.

but most asthma is controlled carefully with steriod inhalers which have less risks than oral steriods.

Oral steriods are rarely prescribed for a prolonged time, and so can not give the long term effects that previous generations seem to have suffered.
Children do tend to grow out of asthma, or have much less trouble controling as they get to adulthood.

write down a list of your concerns , and talk to your GP.

BTW

1200 people die in a year from asthma in the UK.

Podsquash ( lovely name btw!!) What William's mummy said. My son has also had various ashtma meds inlcuding the inhaled steroids since he was a few months old, and the dosc have always trodden a fine line with the steroids, and he has had the smallest possible effective dose.
It is TERRIFYING when they struggle for breath - my son asked me two years ago if he was going to die - I can't tell you how I am haunted by that moment.
When I was @ school (many many years ago) my friend's brother died in an asthma attack. That also haunts me, and I am immensely grateful that asthma meds have had so much research that we are better able to control it. Stunted growth sounds scary, but there is a compromise. My son is above average height - given the heigh of DH and me he is what we would expect. His younger brother will be taller, but I don't think that can be put down to the miniscule amount of steriods DS1 has had - he has a different physique, and DS1 shows many traits of his grandad who was tiny, so he is actually taller than we might have originally expected.... he does lots of swimming and is quite muscular, does not seem to have affected him in that way. And, he is just 11, and starting to get a little moustache, and has confided to his dad that he is getting hairy 'elsewhere' so no worries on other development issues. (Sorry if this too much info!)

Thanks everyone for your thoughts.

Williamsmummy - I'm very much aware that asthma is a big deal. I just want to make sure that I am definitely doing the best thing for my child and want to get lots of input (of course from professionals too) before making a big step. We have had lots of success with alternative therapies in our family so steroids is a big deal for me (as I'm sure it is for other people too). In no way am I saying I want to keep him off steroids if that is the best thing for him. I just have some processing to do.

Anecdotes like yours help me, Mumfie68! So thanks.

And thanks, MrsGuy! I have also seen my son have 4 terrifying asthma attacks, always because of an allergen trigger. I also knew someone who died at school from an asthma attack. It is awful and I want to do everything I can to avoid that. But the clinic said that until he develops these interval symptoms (i.e. when there is no known trigger) then steroids aren't necessary, although avoiding allergens of course is necessary. I just need to be sure that I am moving on to the steroids at the right point, I guess.

Hi,

Asthma is a huge problem nowadays, but there is an ancient, DRUG-FREE solution for it now called Salt Therapy (Halotherapy) available in South-West London (Earlsfield). There is a clinic with an artificial salt cave and playcorner for children and with the help of a medical device they can recreate the microclimate found in a natural salt cave. There are comfortable chairs in the cave and the atmosphere is very relaxed. A session takes an hour and all you have to do is breath normally. Children really enjoy the environment and they do not even realise that they are under a treatment. In order to clear the whole respiratory system and reduce the symptoms 15-20 sessions are needed. The first session is free! It is worth to try, you have nothing to lose.

podsquash just to echoe what everyone else said really the risks are minimal on inhaled steroids.
my dd was diagnosed asthamatic just over a year ago. when she was 18 months. she has always been small for her age. so when doc said about the inhaled steriods i was concerned on the affects of them
what my doc says helped put it into perspective, if she can't breath then she can't run about and play like oother children, also if can't breath properly then she doesnt have the oxygen in her blood to help her grow. there is a minimal risk that the steroids will affect her growth, but it means she will be able to breath and play like other children.

she is still smaller than most children her age, but she is growing slowly. and she managed to walk and run around a wood for 2 hours straight on sunday i am amazed. ( she is 2 3/4 now)

All 3 of my boys have asthma. One of my 4 year olds is currently on a very high dose of steroid, higher than the recommended maximum. I have queried this with our consultant who has assured me that although, yes it is possible to have side effects, they are very rare. And apparently using a spacer means the medication goes directly to their lungs, rather than being absorbed into their blood stream which would cause the side effects.

Our asthma nurse also told us that stunted growth would be more likely to occur through poorly controlled asthma itself.

My 12 year old DS has been on steroid inhalers since age 5. He is small for his age - but he already was before he had asthma!! He has continued along the same centile.

My 4 year old twins have been on them since 10 months and are whoppers!

My twins have both suffered terrible asthma attacks, one near fatal involving cardiac and respiratory arrest. I have no hesitation giving them their steroid inhalers, which are also preferable to repeat courses or oral steroids.

Hi, My son who is 3 has in the past had mild asthma - triggered by viruses. He has an inhaler and we use montelukast at night when he has a cold. Today however his asthma was the worst it has ever been, he is in great spirits but breathing really fast and very wheezy, but still playing and rushing around as normal (I am trying to slow him down).

I took him to the GP tonight and he gave us a new spacer and told us to keep on the ventolin and montelukast but wants him to have a 3 day course of oral steroids - prednisolone. I have the perscription, but I have not given it to him tonight, just reading the side effects and warnings about keeping him away from infectious disease / chicken pox (he hasn't had). He is at nursery and I started worrying the implications of him being exposed to bugs whilst on the oral steroids.

I thought I would start the oral steroids if he gets worst - is this silly of me, should I just start them? I'd appreciate some thoughts. Thanks!

Sounds like my DS - always running around even when he can't breathe!

TBH I would start the oral steroids, they can take up to 24 hours to kick in and meanwhile his asthma might get much worse, kids can go downhill in hours. DS has often had oral steroids whilst at preschool/school and so far no problems. Unless there's actually chickenpox currently at the nursery I wouldn't worry, and if there is - give him the steroids and keep him at home.

Good luck, hope he feels better soon!

Just to add another experience - my DD1 has been on inhaled steroids for 6-7 years and at 11 years old she is 5' 2", very strong, very sporty. According to our doctor, the inhaler she is on now, Flixotide, works effectively with a lower dose of steroid than the Beclazone that she was on until earlier this year. She's been prescribed the Flixotide because it works better for her than the Beclazone, rather than because of concerns about the steroid dose, but it might be worth discussing with your GP which medication would provide the best effect for the lowest steroid dose.

MelissaClaire - give your son the medication he's been prescribed, and ring up and speak to your GP if you have concerns about side effects.