Asthma/school/cats

[Asthmakitty]

My daughter was diagnosed with potential asthma after 2 years of working out what is going on.

A week before she was diagnosed we got two kittens. Two months later we got a beloved sphynx. She has always lived with dogs, and even cats when she was smaller (5 now)

Her asthma in general is getting worse and worse. Her pumps are needed more often. She is on the brown twice a day at 2 pumps and blue when needed up to 6 every 4 hours. Including medicine of an evening to help nighttime asthma flare ups. They are never this bad when at home in general for longer periods as I give it when needed.

My question is this - when she flares up badly we are told 6 pumps every 4 hours when she is awake. The school haven't been following this. Could this be potentially why she is getting so bad? As the reason asthma became something the doctors looked into was due to her health issues.

We are taking her privately to be tested for a cat allergy. But this honestly is throwing me. As she was fine with cats when tiny. Is and has been for nearly 5 years with dogs. Its only became more of an issue since the school isn't listening. I also now knowing asthma is a very likely thing, cat dander can play a major part.

Ofc this is all very distressing for us as a family. My daughter especially is very animal focussed. I don't want to part with them unless its needed for her. As ofc she comes first. But I also feel like there are contributing factors which aren't being fully addressed either.

When I called 111 last night they advised they wanted to raise a safe guarding concern for the school as they hadn't done what they were meant to. Which I do agree with. But I also appreciate its all still early days and they are learning as I am, her warning signs. And ofc I have the upper hand there as I know the signs I'm learning are pump worthy, are things I've always said "she is getting unwell cos of xyz" .

The school need to be following the plan for management of her asthma. If she can't breathe adequately at school and is not being given the inhaler as needed, she's coasting on not being able to breathe properly throughout the day, potentially triggered over and over again with numerous attacks and her airways getting tighter each time. They do not want a serious incident on their hands, asthma needs to be kept under control. I'm not surprised 111 have said that.

Pets, carpets, upholstery that can hold dust are all bad for asthmatics. So is warm, dry heat, hot and humid weather and cold weather getting to the chest. There could be a number of factors triggering it or making it worse unfortunately. I'd start with regular hoovering and cleaning of upholstery and bedding. Plus airing out the room more. No animals in her bedroom either. I'm allergic to cats and dogs but have had cats in my childhood home and do as an adult now. I get used to their dander and a month or two in its usually fine. However, I notice I can breathe better if mine has not been around for a few days, for example at the vets. Also, not sure if this is correct but I was told by a friend that sphynx cats were worse for her allergy as they don't have any hair and the dander is on their skin so it's direct exposure.

Have they looked at upping dosages/changing the "preventative" (brown inhaler)? She shouldn't really be having 6 pumps in 4 hours on a regular basis, that's for bad flare ups and badly managed asthma.

If she’s at least 5 surely she can take her inhalers herself? Have them in her bag and she takes them at lunch.

It’s really the brown inhaler that is more important. The blue just offers relief. So even doing the blue every 4 hours isn’t actually providing any long term benefit.
It sounds like she either needs an additional inhaler or another element added in her care plan.

There is every likelihood that the pets play a role in this thought and that’s something you need to accept.

What have the school been told, is it on her prescription and in her asthma plan?
If it is in her prescription/on the asthma plan that she receives 6 pumps every 4 hours then that is what should’ve been happening.
My only query is the use of the language ‘when she has a bad flare up’ - who decides when this is? are school being asked to make a judgement call or do they go on your say so? Doctors? What? Are they concerned about overmedicating her?
If it’s not on the prescription or in the plan I could see why school might be struggling a bit. They’re not medically trained.

No school is going to allow a 5 year old to be in charge of carrying and administering her own prescription medication! What if another child gets hold of it? She loses it? She takes it and then forgets? She’s 5 can she tell the time to know when the 4 hours is up? My 5 year old couldn’t administer her own inhaler effectively.

It is worth finding out what she is allergic to - that can change over time.

Thank you so much for your detailed reply.

This is my argument with the school. As she will have a terrible night due to coughing and I know that is a warning sign. But get told she isn't coughing at school, as she's handed over to me coughing. And her friends mention she has been to their mums.

I hover twice a day. Last right before bed. But the problem comes up as they both cosleep with me. The cats aren't allowed in then.

But ofc by then dander is everywhere. And I can't close mine, and both of their bedroom doors as at that point they have a limited area to freely move around in. As although my dog is fine with them, they like to avoid him.

I also on my Google found sphynx can be worse as they lick their owners a lot a saliva is part of the issue. And gosh does my girl love attaching to my babies neck.

I just can't believe how cruel life can be. A little girl who adores her animals is being told she can't be near them.

Make sure she has a written asthma action plan and give a copy to the school. I give parents 2 copies for this reason and stress the importance of giving one to the school to keep with the inhaler. It tells them the warning signs and when the inhaler is needed, when it's bad enough for 999 etc.
6 puffs of the blue is a lot in one go though. 2 puffs should be enough for relief of symptoms. If she's needing that much more than very, very rarely I'd say she's not well controlled. Poor control is needing the blue more than 3 times a week.

You need to get her allergy tested - probably skin prick to find her allergen(s). One of mine is allergic to only cats.

I regularly used inhalers through primary school and it was never done by a teacher. In fact a huge focus on the asthma clinic was always to teach us how to properly and effectively manage our own inhalers.
OP doesn’t say what age the child is, just that they’ve had dogs for 5 year so she could easily be a few years past that.

Wonder if the doctor might recommend trialling an antihistamine to combat a potential allergy.

It’s possible to be allergic to one cat and both the others. We had multiple cats growing up (always at least two, often more), I was allergic to one of them, but fine with others. I was able to manage it by keeping her out of the bedroom and not Leo her sleep on any of my clothes.

It sounds to me like your daughter needs better/different inhalers. I’m asthmatic and the brown ones did nothing for me.

have you ever tried her on antihistamines?

@Sissynova The op says the child is 5 now.
How long ago were you in primary school?
Medication rules have changed over the years.
I work in a school and a 5 year old would never be given responsibility for their prescription medication. The risks of something going wrong are too high. In secondary things would be different.

Could you keep the cats downstairs?

We limit the movement of ours around the house at night. He'd be waking everyone up if he had the opportunity.

All of this is brilliant advice. The school need an asthma care plan for her. She should have an IHP that is checked and reviewed by you annually. I was asthmatic and developed rhinitis as a child (thankfully grown out of both now) the best things is to have as little dust in the house as possible so hard floors are perfect - even in bedrooms! It really does make a huge difference. Your child may also be affected by pollen so DONT open windows in her bedroom at this time of year. Try and dust/hoover her room every few days, it made such a difference to my symptoms to have as little dust as possible where I was sleeping. Also hoover mattresses when you change sheets and replace the pillows regularly. Hopefully if her histamine level drops you will see a relief in her symptoms.

The official asthma advice is that children should a have access to their inhaler at all times. It shouldn’t be kept away in a school office for example. Even in primary.

My DD obviously does not carry her inhaler in nursery but I would expect her to have easy access to it in school.

I think there are multiple issues going on.

School should be following her asthma plan. She is probably ok at school because you have given her doses in the morning before she goes. If school hand her over to you coughing it is because they have not been giving her enough inhaler during the day. This means she will be worse in the evening.

I used to use the brown preventer inhaler but the pink one is so much better. Ask for an asthma review with the asthma nurse at your GP practice.

Could your dd also be suffering from hay fever? People who are asthmatic often get hay fever too. Both restrict breathing. Ask if DD can try hay fever tablets. They are basically antihistamines. I get both and my asthma is always so much worse on days with a high pollen count. My GP gives me a nasal spray.

I would sort out these things before turning focus to cats. If she was ok with cats before it would be less likely that suddenly she has a reaction to them.

I think you need to speak to school safeguarding lead as asthma can kill. I get asthma badly and I have had to be given strong steroids to control an outbreak. One of my best school friend died from an asthma attack two weeks after having a baby. She was home on her own with her baby and she got a bad attack and could not get to her inhaler. This was before people had mobile phones.

It helps to do damp dusting every other day in the summer to damp down pollen.

Good practice is to have them available in the classroom but under the supervision of a first aider. Not just kicking round in a small child’s pocket or draw.

There’s plenty of things that could be triggering asthma other than cats, so get allergy tests.

6 puffs every 4 hours sounds like her asthma is NOT under control at all. I don’t know who has drawn up the asthma plan, but ask to be referred to consultant.

Do the school know the signs of an attack? My sons were very quiet, I had to show the school exactly what to look for.

Isn't the obvious answer to get rid of the cats. I was diagnosed with asthma age 6 and was fine with animals when younger then it just crept up on me. Your putting the cats before the child's health.

You need to get her properly allergy tested. You should not need to go private, though obviously you can. If she's allergic to cats you probably need to rehome the cats. You also need her doctor to help you agree a proper management plan with the school. Book an appointment with the doctor and ask for their help. And find out who is in charge of administering medication at school. Talk to them too, or ask your doctor to do so.

Your daughter’s asthma control and treatment sounds really inadequate. She’s either got poor inhaler technique and isn’t getting an adequate dose or she needs more preventer treatment if she’s using anything more than minimal blue reliever regularly. The aim of good control is no symptoms and no reliever inhaler use. Personally I’d say a child requiring 6 puffs of salbutamol every 4 hours is likely to be too unwell to be in school and probably needs an urgent review for rescue treatment (e.g. oral steroids).

As others have said her brown inhaler should be controlling her asthma so she doesn’t need the reliever. Does she use a spacer with her inhaler? Do you have an asthma nurse you can review this with? We were told cat and rabbit hair are the worst types of hair for allergies. What happens if she stays out of the house for a few days (at grandparents or if your on holiday? If it improves then the cats are likely to be the issue. Also at this time of year my dds got hay fever which always made their asthma worse - once that was controlled with antihistamine tablets/and or nasal sprays asthma was much better. Hope she’s feeling better soon 💐

@BungleandGeorge beat me to it. Your DDs asthma is not under control at all. She should not require that level of blue puffer routinely.

Has she ever been to hospital and seen by a consultant? Or is it GP care so far? If she is coughing at night again and the blue puffer isn't completely easing it, I would take her in to hospital.

Absolutely agree. And not sure your DD is fit for school needing her inhaler so much.