uncontrolled asthma in a 4 year old

[cedmonds]

HI
My son who is four has had asthma since he was tinny. Last year it was really bad this time of year and he also got swine flu which led him to get phueioma(sp).
He has not had his asthma controlled now for a month he has had so much time of school because of it at least one day a week. He went to fireworks on Friday in the rain and seemed fine and then went to a birthday party yesterday and came home a bit wheezy. He woke in the nigh which a high temp which came down with calpol. He was then really wheezy during the night and was going blue around his lips. He got better with lots of Ventolin. his morning he was still wheezy. I then took him to the out of hours doctors at our local hospital. The said his chest was very wheezy. They just said it was a virus and said to go home and bring him back is he got worse. He has just flopped all day and watched DVDS.They have given him oral steroids in the pass and have said that he could of have them again if he was wheezy which he was. I just don't understand when they said he could of had them if he was wheezy which he is so why not give them to him. Sorry for the long post just really worried about him he is not right at all cant breath properly just lying there.

I would get him seen again before night. My 4 year old dd has asthma and once she is wheezy she always needs steroids (and usually nebuliser and oxygen) or she gets very ill very quickly.

The nights are usually worse for children with asthma so if he is struggling now I wouldn't wait til tomorrow.

Hi
Thanks for the reply, pixie
He is under the peads at our local hospital he has been seen last month and they said just to keep his meds the same and to take him back in Feb. He is on Flexitide and cetrizine. Yes he is having four hour ventolin 4 puffs.
My DH has come back from work now and i have phoned the out of hours just waiting for them to give me a ring. I have looked at the asthma thread and seen you on it a lot have you got any ideas of meds etc that i could talk to the gp about he cant go on like this.

HI suiledonne
I got told that they dont give nebuliser to them any more just 10 puffs of ventolin which is ment to be the same.

My dd is on Singulair - started this time last year after a terrible 6 weeks when she ended up in hospital 3 times despite being on Becotide and Ventolin.

The Singulair made a huge difference. In the year she has been on it she has had only a few attacks and they were a lot milder.

HTH

Hope your ds feels better soon.

Ask the out-of-hours directly for oral steroids, and politely persist.

Afterwards, ask for another paed appointment at the hospital sooner rather than later, once you're past this immediate crisis. They need to help you plan for times when his asthma gets worse. My DD sees a paediatrician twice yearly for asthma, but they did say that if she was ever having problems, I could ring up for an extra appointment. Worth a try?

I'm in Ireland so probably different here but dd had nebuliser every few hours when she was in hospital in Sept. She always needs oxygen during an attack too though.

We have a home nebuliser and have been told if she is bad enough to need it then she needs to be seen although we have used it recently to stabilise her a bit while getting ready for the trip to the hospital.

Hi
Thanks
He was on siguliar last year and it gave him really bad nightmares it just didnt agree with him.I wonder if it is worth a try again though. I have got a prescription for him DH has just gone to pick it up. What is your school poilcy about them being in school with asthma. DS is being really hard work didnt want to give him ventolin etc untill they spoke to the gp, as they said he should need it every day.

My dd is in pre-school. I have explained to the staff how to use her inhaler and mask if needed and to call me if they are worried but I don't send dd to school if she has a cold as that is what tends to trigger an attack.

It is fine this year but I haven't thought through what will happen next year when she is in 'big' school.

Pixie Our nearest A&E is 40 minutes away and there is now talk of them closing that hospital I just don't know how we will cope if we have to go further. 999 i'd say.

hi
ds pre school was really good with his asthma. He was having it every day before going out side to play in the winter. Whereas school which is a tiny two classroom infant school does want to do it. Pixie how old is you dd2?My friend was saying he should have things to do at home as he is missing so much but is it really that important and the moment he knows all his letters etc?
Suile thats really bad i would hate to think what would happen is they closed our a+e down. DS has had nebulisers before but it was the doctor today said they dont give them any more.He is now in bed he is so tried bless him hate to think what time he will wake up tomorrow though.

Hi PIxie
I was just wondering if they have said that it could be hormonal. My sisters asthma got really bad and that age and then got better again when her hormones settled. So do you think i should say to the school about ds having things at home to do or just leave him to get better.

what has the doc said about his preventor medication? any talk of changing it ?

do you do a regular peak flow check to see if lung function is still ok?

He has never had peak flow done i always thought he is too young.
Sorry pixie i was also ment to say that must have been awful, and theres me stressing about ds.

Thanks
Thanks that i thought about asking for things for him to do he really enjoys reading eggs online ( an online reading game )so he has been doing that.Have you every found steam helps?He is in bed coughing at the mo just wondering if it helps. I will mention the peak flow when i take him to the gp. I will ask to see the asthma nurse as she is really nice and takes it seriously,which our gp dosnt sometimes.

Have a look at the British Thoracic Society's guidelines on asthma management in children. There's a stepwise approach to it, and different drugs do need to be trialled on each individual in a controlled way, so asking for certain things may not be welcomed by whoever you see, or indeed be very useful. If you can't find the guidelines on the BTS website (TA10 and TA131 are both useful - read the quick ref guides).

The other thing to ask is whether your DS can use his inhaler without the mask but with the spacer. If so, he'll get a lot more of the drug in him as a lot gets lost in the mask.

If it was me, I'd get him seen then ask for a referral to an asthma specialist asap. If there's an asthma nurse at your GP surgery, or a GP with an interest, ask to see them.

I'm a pharmacist btw, as well as a mum of an asthmatic DD (4yo), so I'm not just talking out of my bottom!

Good luck.

Sorry, I meant to say that if you can't see the stuff on the BTS website, look at www.nice.org.uk for TA10 and TA131.