To not agree with the nurse practiser's view that my DS has asthma and to think a diagnosis should come from a doctor?

[PolkadotCircus]

Soooo my v healthy but skinny boy 9 has had a nasty winter virus that he has had problems shaking off,symptoms involve a cough that won't go away.Loads of other kids and adults have had/got it here.

The same happened last year and our fab doctor gave him temp inhalers to calm his airways down which worked a treat and were never used again.

His grandad is the same(very skinny and some times gets a chest infection in winter it takes a whole to shake off) but still cycling 16 miles a day at 80.

Anyhow dtwin 1 keeping dtwin 2 awake so tried to get an appointment with our fab GP but because he is so fab it is nigh on impossible so was offered an appointment with a nurse which I reluctantly accepted as all I wanted were temp inhalers and ds better ASAP.

Anyhow after a very lengthy appointment when his puff was measured,history looked at,records filled in,weighed etc she finally gave us some inhalers.Puff was poor(errr yes he has a virus and a temp) and we were told to come back for a follow up asthma review.I said but he doesn't have asthma only to be told well this happened last year etc,etc.

So we went to the review puff beyond normal now and very good,virus over so no surprise.Nurse then said as he had asthma she'd like to see him again,keep him in her records,how many inhalers did he have etc,to keep him topped up when tight in the chest etc etc.

I said very firmly he doesn't have asthma and never gets tight in the chest.She then asked if he had eczema or hay fever.He had eczema as a baby and gets a bit sneezy in the summer ahhhh then they are linked so he does have asthma.Me-no he doesn't he just gets a cough he can't shake some winters.
I don't want asthma on his records unnecessarily.We politely agreed to disagree.

So aibu to think a)he doesn't have asthma and b) a diagnosis should come from a doctor.

HazeyJane - is there a reason seretide isn't usually prescribed for under 16's?

My 9yo DS2 has a seretide preventer. He was given it 6 weeks ago, and his asthma is under control for the first time in his life. He can run with his friends in the playground and doesn't have to sit out after 5 minutes of PE!

But now you've said that it's not usually prescribed for under 16's, I'm a bit worried as to the reasons WHY!

Just to add, eczema and asthma are linked, she's not just enquiring just for fun.

Another YABU I'm afraid.

My DS is 5 and has been severely asthmatic since around 3 yrs. You have no idea how hard it was for me to get the kind of attention they're giving your ds. I had to fight to get a consultant in the end.

My ds's asthma ^always^ starts with a cough and he very quickly goes downhill in an attack. Very little wheeze btw. He's been admitted 5 times in his life and we've been close to loosing him twice. The first few times we were told it was a 'viral wheeze'. In my mind, they are virtually the same thing.

Don't take this lightly. Definitely see the GP about it, but don't fight the asthma diagnosis if its given. They won't give him anything he doesn't need.

Just to add too, yes eczema, allergies and asthma are VERY linked. The nurse is trying to build up an accurate picture of your son.

An asthma nurse knows their stuff. Please don't brush them off.

My very good friend is a practice nurse.
She told me I sounded like I had asthma, but I argued and said it was only the aftermath of a cold. She told me to get it checked out...and she was spot on. She deals with all the reviews of asthma and knows what to look for. I only get affected in cold weather/after colds but it is still asthma.

To be a nurse practitioner, you have to go through masses of training, so YABVU to think her ability to pinpoint your son's health problems are not to be believed as she is 'not a doctor'

I won't Harry if he has it rest assured we'll have inhalers littered everywhere..

Tis odd that kids with serious symptoms have to fight for treatment and my DS with zero symptoms seems to be being channeled down the route ASAP with very little room for any questions.

So now he's been diagnosed too quickly. We can't win.

Seretide 100 acchualer can be used in children over 5 and the 250 & 500 over 12.

The ordinary inhaler 50 can be used in children over 5 and the 125 & 250 in children over 12.

In general though most children are well controlled with a steroid alone with a salbutamol inhaler.

Seretide is the next step up the ladder when a steroid alone is failing to control the disease.

Was it one of these he used? As I said, with peak flow, whilst there is a range of expected measurements "it is possible for people with asthma to have a better PF (when well) than would be expected" - getting 100% of predicted PEFV for a boy of his age & size when well is obviously good, but doesn't preclude his being asthmatic.

You should make the school aware of what's going on, yes. To be honest, you could really do with having more than the one inhaler. Until you have more than one the one you do have should be on/with/near your son at all times.

While you're waiting to see your GP please check out the Asthma UK stuff I linked to: they'll be able to give you lots of advice & information to help you ensure the safety of your son.

And also, asthma can develop at any time - you don't have to have had it since birth.

My own asthma was diagnosed when I had a spectacular attack on my 9th birthday (summer birthday) and was blue lighted to hospital.

The only outward sign before that was that I had had a cough the winter beforehand that wouldn't shift.

I have had at least one bad asthma attack EVERY winter since.

It's not a bad thing that they have picked it up so quickly. Would you rather wait for a diagnosis until your DS is blue lighted to hospital and put on nebulisers and oxygen?!

Why is a diagnosis of asthma such a 'bad' thing to you?

It's just a name for what is happening to your DS when he gets a virus and needs an inhaler.

I don't get the problem?

I agree. Ask for a second opinion. It's not to say she is wrong. I didn't think nurse practitioners were allowed to diagnose illnesses.

Pebble. I don't get your post.

I took the nurses appointment instead of the GPS but considering as a family we rarely as a 5 visit the practise at all when I want to see a doctor I will do until the day doctors are no longer seen as necessary.

Zebra yes think it was the peak flow metre thing.Many thanks that was kind to put all the info up.

Yes the lack of extra haulers,need to tell school etc was another reason I'm a bit surely you either have asthma or you don't.If you do then there must be a need for extra inhalers,info sheets extra.You can't just say you've got ***,next patient please.

I also wasn't aware NP could diagnose and as I said we got the referral from the receptionist not the gp.

That would be inhalers not haulers.

He hasn't got zero symptoms. From your description he's got several indications.

Had to pay best part of £30 for 2x meds and the machine thing.

How? Prescriptions last year were about £7 per item. I make that £21.

Avoidthetrees - DS2 is on a seretide 100 inhaler.

(For some reason Autocorrect keeps trying to change seretide to secretive?!)

He has had numerous hospital admissions, has development delay as a result of his oxygen SATS dropping too low during one hospital admission (he has nearly died 5 times from his asthma), they upped him to an adult dose of Becotide and it still wasn't controlling his asthma.

The seretide is.

It's amazing to see my DS2 blossom now that he can join in properly playing with his friends at break time and lunch time!

You're welcome for the info: I hope you find it useful - Asthma UK can be a brilliant source of help & support.

Is it possible that the NP felt you weren't going to be receptive to further information? Would you, truthfully, have taken (& then read & if necessary acted on) information sheets etc if she had offered them to you? Your OP doesn't sound as though you would've done so. Perhaps she thought there was no point in writing a prescription if you weren't going to get it filled & no point offering you a leaflet if you weren't going to take it/read it. Did you tell her you'd be consulting the GP about it? If so she might've felt it was more appropriate to let them talk to you than to keep pushing the issue.

Sadly I get this attitude a lot.

I'm a practice nurse who also happens to be a primary care respiratory specialist nurse (I have diplomas in Asthma and COPD Diagnosis and Management in Primary Care).

The GPs I work for will send patients with suspected asthma and COPD to me or my nurse practitioner colleague who holds the same qualifications as I do, as our knowledge is comparable if not exceeding theirs.

Unfortunately some patients think because we don't hold the title Doctor we are incapable of diagnosing or managing their condition which is very frustrating. Some will, after a few appointments, acknowledge that we do actually know what we're talking about whereas others insist on going back to the GP who tend to give them a polite flea in their ear and tell them to rebook with us!

OP give the nurse a chance. I wouldn't necessarily have the time (or want) to give all information in the first appointment.

PolkaDotCircus - I would tell the school, so that they are informed.

The likelihood of a serious asthma attack is minimal, but my own experiences say that it's not impossible.

I had no outward signs that I was going to have a serious attack other than a bit of hayfever in the summer and a persistent cough the winter beforehand. Yet it still happened.

If it was me, I would want the school to be aware so that they can be in the lookout for symptoms. They are in loco Parentis, and responsible for your DS for 6 hours a day - I would want them to have all the information about his health.

And surely you don't need to give the school your only inhaler - it should stay with your DS? My 9yo DS2 keeps his blue inhaler in his trouser pocket so that it is to hand if and when he needs it. He can manage that, and he has additional SN's and a connective tissue disorder. I'm sure your DS can manage it?!

Nope didn't mention the gp.

I actually asked for the inhaler prescription,'twas the whole reason I wanted the appointment.Just wanted temp inhalers,last years got lost,may have been the year before,can't rem-we may have binned them after they went out of date.

I asked very polite questions. I really did.

I also wasn't aware NP could diagnose and as I said we got the referral from the receptionist not the gp

You seem pissed that "only" a receptionist referred, but was it really a "referral" or simply the receptionist offering you an appointment at the practice Nurse Practitioner that runs the asthma clinic? Your DS does have symptoms, you have ignored the countless people on this thread who have said breathlessness, wheeze etc is not the main symptom of they or their childs asthma but a persistent cough is.

Is it. I've just read your post about having four episodes of wheezy coughing since August. I might be crossing a line here but could I ask you not to wait until he gets another episode and to seek a second opinion if you don't get an inhaler or a referral to an asthma nurse or a respiratory specialist.

4 years ago I started to develop mild asthma symptoms similar to the OPs DS. No wheezing, persistent cough with viral illness or around cats. I was having symptoms maybe once or twice a year at most. The rest of the time I was fine (running 20 miles a week, able to swim 35-40 lengths of the pool.) Fortunately, I was given an inhaler by my GP who suggested mild asthma. About 18 months ago, completely out of the blue I had a huge attack at 5am one morning. If I hadn't had that inhaler to take I'm not sure I would be writing this post today.

It is unusual and it will probably never happen to your DS or the OPs DS, but not taking symptoms of asthma seriously can be fatal. Four episodes over 6 months is too many. If it is asthma the right medication may mean he doesn't have any and could prevent that major attack from ever happening.

Sorry, that's turned into a bit of an epic post

On the one hand, you insist that your ds doesn't have asthma and you don't want it on his record, on the other the only reason you made the appointment is so that he can have an inhaler?

You aren't making any sense at all. Just go and see your GP and get your ds the treatment he needs.

Clay that isn't to me is it.

He had a persistent cough after a virus this year and one the year before I think.Rest of the year nothing no cough at all.Never been breathless or wheezy-ever!had Excema as a baby(but many babies do)and I told her it was after the jabs.