GP won’t treat DD

[redfox14]

My little girl (19 months) had bronchiolitis in July and since then has had nonstop illnesses, always affecting her chest very badly to the point she has wheeze, struggling to breathe, coughing until she gags/vomits. She has been admitted to the children’s ward 3 times and given salbutamol. After this she is always much better and sent home with no medication or treatment. Told by paediatrician that she has reactive airways and will react this way every time she gets poorly as it will go straight to her chest.

I have been to the GP 3 times asking for an inhaler (either rescue or preventative) and been told she doesn’t need one. One doctor on children’s ward said they would prescribe one on discharge with a wheeze plan but they finished their shift and was discharged by another doctor who said since her chest had cleared (after the salbutamol) she didn’t need an inhale.

today is the third occasion in 4 weeks we have been admitted to hospital. No one will give DD any medication of any sort. I feel that it’s cruel to not even give her a trial of an inhaler if that’s what is helping her in hospital! Every time we’ve been seen, we’ve been told by nurses/doctors that this will keep happening until she grows out of it/diagnosed with asthma. Surely it’s not right that we have to have her admitted to hospital every other week? I am at my wits end, she finds it so distressing, I just wish there was something I could give her at home and I’m sure an inhaler would help.

AIBU to insist that she needs an inhaler??

We had the same issue with my son. In the end we lucked out because my DH got diagnosed with Asthma so as there was a family history they prescribed one for him. Have you tried a private GP yet?

@Ozanj oh really, neither DH or I or asthmatic. We haven’t tried private yet but I am tempted. Did the inhaler help your son?

She sounds like my son. We had a horrible winter when he was 1.5 and had bronchiolitis and repeatedly rsv. Spring wasn't much better. We were in and out of a n e and were told to use salbutamol as soon as he got a cold. We did and still kept ending up in a n e all the time when we couldn't manage with just salbutamol. He must have been on antibiotics every second month as well as his gp kept insisting that with his his tendency to wheezing he is more at risk of developing a secondary bacterial infection.

Anyway, We finally saw someone privately who prescribed a brown inhaler. His GP had also referred us to see a pediatrician but the waiting list was about 18 months. Since starting the brown inhaler we have not had to go to a n e. We wanted to stop the brown inhaler over summer but as soon as we did he started wheezing and coughing..maybe he's got hay-fever as well. We have since seen the NHS pediatrician as well and they too have suggested thst he needs a brown inhaler.

Anyway, long story short: I'm not sure a GP can prescribe the brown steroid inhaler. I'd go private if you can afford it and insist that your gp refers you to a pediatrician. I have been told that repeated swelling up of the airways can cause long term damage if it happens too often.

Oh just reread your op. So the gp won't even prescribe salbutamol? Ours did and we gave it to the nursery staff as well. If it wasn't for that he'd have ended up in a n e even more often, I'm sure.

This is exactly what happens to my 5 year old every autumn and winter. We now have a brown inhaler on prescription and about 10 blue inhalers throughout the house as they seem to give them out like candy to us every time we go near a&e.

Just going to give you an outline of what happens with my son so you can compare to your child. If yours sounds similar to this then I’m shocked they haven’t prescribed a brown inhaler and also given a blue for times he is struggling:

1. Repeated a&e trips, always has to stay on children’s ward for a couple of nights, once it was 10 days when I left it too long to bring him in (his paramedic uncle told me I was overreacting over Christmas 🙄).
2. My flag for taking him into a&e is when he is coughing a lot and working hard to breathe. Rapid breathing (faster and more shallow than usual), recession at the base of throat and between his ribs.
3. Every time we go into a&e because of it, they take his stats then either put him on a nebuliser or if the stats are not so bad they give him 10 x shots of blue inhaler through a spacer, with 10 breaths in between each spray (this is why we have so many blue inhalers as they let us take them home).
4. they then monitor until his oxygen levels stay above 95% without inhaler over a four hour period. This can take anything from 24 hours to more than a week.
5. no problems in the summer; he doesn’t have asthma. He seems to get the coughs and colds that go around, but be affected by them more than my other children
6. sometimes he is given antibiotics to help clear chest infections.

If your child has only had a few incidents then maybe they don’t have enough of a history to qualify for the brown inhaler? This is the second year mine has been given one, the first was given after 3 winters of the above. I would push for one through a second opinion if I were you. They help keep the flare ups that need a blue inhaler at bay.

Or go to France where you can apparently buy them over the counter for about a tenner!

Oh and our gp prescribes both the brown and blue inhaler

And also meant to say, lots of coughing on its own isn’t necessarily something to panic over. It’s the recession you have to look for that is a better indicator that she is actually struggling. And the rapid breathing. What are her oxygen levels like when she is observed in a&e?

My mother is a practice nurse and can prescribe the brown inhaler...of course GPs can prescribe them.

Yes I should add now our gp also prescribes ds' brown inhaler but he wouldn't do so without an assessment by a pediatrician.

Does DD also have eczema or any rashes/food intolerances? I think I would call 111 next time she’s sick and ask that she is seen by a paediatrician instead of GP as this sounds like asthma to me. (They can normally tell by 1 y/o)

They can voice their suspicions but they don't diagnose it usually till they are older and can do a specific test.

My ds is 3 and they basically treat him now as if he has asthma but he isn't diagnosed yet and they have said there is still hope thst he will outgrow it. He does have a nut allergy as well so the signs are not good.😥

Can you make an appointment at your gp practise with the asthma nurse? There's on in our GP's office once a week and she prescribes all the inhalers and monitors their success.

Thank you everyone for your replies. We have been seen today by a paediatrician who has (finally!!) agreed that she can have a blue inhaler! I asked about a brown one as well and they said for now they are just going to give us the blue, but we are being referred to an asthma follow up clinic so at least we are finally getting somewhere.

That’s great news, well done. It’s so scary when they are struggling to breathe xx

The Clenil Modulite (brown) inhaler is magic. After DS was in twice with very serious "viral wheeze" (it wasn't, he's 6 and has been diagnosed with the same asthma his dad, aunt and grandad have) they prescribed us 2 puffs in the morning and 2 at night. He's only had one episode since and that was 4 years ago. See how you get on - if you need a lot of Ventolin you should get a preventer.

Blue won't do much unfortunately - its not preventative. If you know anyone with asthma just grab some Inhalers from them - my daughter had asthma from birth til age 7 and has now outgrown it and has 'asthma dormant' now on her records. We always have at least 1 or 2 spare Inhalers in the cupboard - for brown just do 1 puff twice a day at first.

It’s not wise to just “grab a brown inhaler” to use. The brown inhaler is beclomethasone, a steroid which prevents asthma. It is not without side effects - young children need to be monitored as it can affect bones and stunt growth, amongst other things. Hence it should be prescribed and the child monitored regularly.
Any inhaler prescribed to a young child should be taken via a spacer and maybe a mask too if very young. You should receive instruction on correct inhaler technique to ensure the correct dose is administered and absorbed.
If you have an asthma nurse at your GP surgery, they can advise and prescribe and are yup to date with most recent guidelines.

Private GP.

WTF?!

My GP prescribed me an inhaler as a preventative (placebo I suspect!) when I had covid - no symptoms whatsoever other than feeling under the weather and having panic attacks about not being able to breathe. She said if I felt it might help me sleep, I could have one. So I did. I used it a couple of times but I didn't need it and then obviously I got better anyway.

I'm genuinely stunned they won't prescribe for your daughter. I think you should rewrite your opening post with timelines and take to PALS. It really doesn't seem right.

My granddaughter born prematurely only needs the inhaler when she gets a cold, cough. My grandson when doing sport especially in colder weather.

I'm so shocked that the GP has been so awkward.

Right at 1, our daughter got RSV, bronchiolitis and a night in the hospital, and from then on was sick at least 1-2 weeks a month for about a year, horrible cough, unable to breathe, gunk in her lungs causing her to vomit etc. This started during peak covid so her doctor refused to see her until PCR tested each time which took days and the worst symptoms had subsided to the point it was just labelled a cold. After about a year of this we annoyed the doctor enough that we were given oral albuterol which helped a lot and we only used when she had a cold. We honestly thought we were being irritating and would have given up but a nursery teacher who has asthma said that she could hear the tightness of breathing every time and was really worried. Eventually we moved house and changed doctors, frankly the new one is fantastic. We brought DD in on day 2 of a cold just so she could see what was going on. This cold compared to the ones before wasn't bad at all, but straight away she said there was tightness of breath and her oxygen levels were low on the finger monitor (makes me dread to think how bad the other times were). She gave us a prescription for a mixed albuterol/steriod inhaler for when our daughter starts coughing when sick, and it has been truly amazingly helpful. Apparently the oral albuterol is an older solution and the inhaler is better as a fix. It comes with a facemask to help her breathe it in as she is young. Our daughter asks for it when she is coughing now, so clearly it helps her feel better. Keep pestering your doctor, the inhaler makes life so much better for us. colds are 3-5 days not 10-14, and nursery and school staff have been much more understanding of lingering sicknesses knowing she has asthma and things stick around in lungs longer. You might want to think about getting the finger blood oxygen monitor too if you are really worried, knowing we had that was actually helpful for our own sanity.

Different country, Dd couldn’t be diagnosed with asthma until she was old enough to complete the tests. That didn’t mean they didn’t treat her as if she had asthma. It was obvious to everyone that it was likely.

For a toddler hospitalized repeatedly, I would expect to have a nebulizer with albuterol on hand in addition to preventative and rescue inhalers used with a spacer. We would call the doctor whenever she got sick because she would flare immediately. they would put her on steroids and have us do regular nebulizer treatments because it’s more effective than the rescue inhaler.