Ventolin making 19mo irate...

[Galena]

DD, 19mo, was born at 27 weeks, but we had a relatively 'easy' ride through 9 weeks of SCBU. However, she has been readmitted 3 times since and put on oxygen each time for bronchiolitis and post-viral wheeze.

The last time she was admitted, she was given ventolin and her wheeze improved rapidly. Since then, when she's had a cold, we've given ventolin and she's avoided another readmittance (Hooray!).

She's full of cold again (great timing!) and so she's back on the ventolin. However, it makes her behaviour really unpredictable. She will fly off the handle at the slightest thing - usually she's fairly docile, but at the moment it's incredible! Since about 5 o'clock today she threw her plate at me at dinner time, tried battering my face when I was cuddling her, took 45 minutes to go down tonight because she was screaming and trying to hit/kick me.

I know Ventolin can make a child hyperactive, but could that be what this is? She seems so ANGRY! It's horrible to see.

She's on a pretty hefty dose at the moment (when she's bad we have to give her 10 puffs every 4 hours through her spacer. Today she's had 10 puffs at 8am, 8 puffs at 12pm and 10 puffs at 6pm) so I'm thinking I may try cutting back slightly and see what happens.

Drs keep mentioning asthma, but I don't think they've given a definite diagnosis yet. Slightly frustrating, but they're treating it as such anyway (have prenisolone to start tomorrow) so I guess it's not too bad.

Might this behaviour be caused by the ventolin?

God - you can tell I'm tired - sorry my post is somewhat garbled! Hope you can see what I'm trying to ask!

(Oh, and I meant preDnisolone, of course!)

I know ventolin when used in high doses gives my sister headaches so perhaps it could be that?

she's getting the shakes because she's overdosing (which may be what she needs, and apart from the horrible feeling you get there are no other side effeccts and it is far superior to no being ale to breathe)

• poor thing, it's a horrible feelig - that's an awful lot of ventolin in one go to be self-administered

why isn't she no becotide or similar - a preventative rather than a reliever

i know when ds was in hospital the wee girl opposite was going mental and her mum swore the ventolin caused it

Thanks for the replies. She's not on a preventer because no-one has yet formally diagnosed her as asthmatic. It's purely when she has a cold that she needs it. It is a lot to give, but if the alternative is hospital admission, I'll give it!

I do judge how wheezy she is, and cut back as soon as I can. Usually she needs the ventolin at a high dose for a few days before I can cut back to 4 puffs when she gets up and nothing else for a few days, then not at all.

She shouldn't need a formal diagnosis to have the preventer. DS has been on daily inhalers since he was 6 months but was only diagnosed as asthmatic at 12 months.

It's tough when they are so little and can't talk to you about how they feel.

We find that DS' (2.5) behaviour is terrible if he is wheezy, he really goes bananas especially at bedtime - won't let us change him, bath him, teeth/pjs etc all a huuuge battle.
I was like it too as a child when I got wheezy apparently. Once the ventolin has had a chance to work he is much better, although the most we need to give ever is 3/4 puffs so not as extreme a case.

If you are having to use so much, I would be pushing for a formal diagnosis and some becotide or whatever they use for little ones. I know most Drs are reluctant to diagnose asthma before 3 usually, but your poor DD sounds in a bad way.

sounds like GP mismanagement to me - have you told them how she reacts to the amount she gets?

If she reacts well to the ventolin I understand that's one of the diagnosis

Call the asthmauk helpline tomorrow and speaak to one of the nurses there and ask their advic - they are excellent and know more than many GPs

Absolutely. Whenever we've had to give dd1 relatively high doses (6 puffs and upwards), she's been off the walls, shaking, hyper, destructive, manic, uncontrollable, nightmare to put to sleep etc etc. Normally she's lovely, not quite an angel, but not hugely difficult.

I don't think you can 'formally' diagnose asthma until much older, but certainly dd1 is down as 'probable asthmatic' after a hospitalisation at about 2.5 and has been on a preventer (which has helped enormously) since then (3.3 now).

Good luck. The high doses shouldn't be for more than a couple of days so hopefully better soon?

By the way, we were told that if we ever had to give 10 puffs, we should be going down to a&e anyway? Might be worth reviewing your management plan with the doc at some point (although if it's working now, then very good!).

Thats interesting about the sleep lukewarm. DS has been on high doses of ventolin for 4 weeks and his sleep has been awful for a similar amount of time but I never but the two together.

DS has a formal diagnosis of asthma at 12 months but only due to his extreme history and the family history aswell but they don't normally do that til 3 but still treat as Asthma anyway. So formal diagnosis or not shouldn't make a lot of difference to the treatment given.

I would also be asking for a referral to the hospital, or at least an asthma nurse so you can get a second opinion.

I feel for you, we have had about 17 admissions in the last year with the same thing. However, if she is needing that much salbutamol she really needs to be seen. That high dose could lower her potassium levels which is dangerous and she really needs her oxygen saturations checking. Hypoxia ( low oxygen) could cause the behaviour you describe.
I totally understand your reluctance to go in, I hate it too but I speak from experience and as a doctor.
I hope she gets better soon

Thanks all - really interesting stuff. I hadn't really thought about the fact this could be ventolin related until tonight, so I didn't mention it to the Dr. I will when I next go though. I'll also ask about a preventative.

Slight complication which is that we're going away tomorrow for 2 weeks, so we won't be seeing our doctor till we're back. (Going away in the UK, so will have access to Drs. if needed)

Will see how she is tomorrow and reduce puffs and see what happens.

Thanks again.

My dd is also 19 months and is on prednisone at the moment. She is on 4 puffs every 4 hours. She's also had bronchilitis 3 times (last winter) and think she will be asthmatic but are reluctant to diagnose as she's so young. She is on a preventor called clenil modulite. Her mood since Friday has been awful, lots of crying and very upset. Had her chest checked again today and gp said much improved.

So you have my sympathies, I hope she's better soon. The steroid tablets help loads, but they can make them hyper.

That should say she has 4 puffs of ventolin every 4 hours lol!

As others have said, Ventolin can make then hyper and unpredictable.

My two boys have been diagnosed with viral wheeze - it's not true asthma but they get asthma symptoms when they get a cold or virus. It sounds like your DD has this too.

My boys have both been on preventors since they were about 1, so she is certainly not too young to go down this route, and if you are having to give 10 puff doses, is sounds like she needs it.

With Ds1 (now 4)we tried various preventors until we found a combination that works. He's now on Seratide and a tablet / powder called Montelukast.

Ds2 (now 2)is on an orange puffer called Flixotide, which beens to work for him.

It took some pushing to get them onto these drugs, but it's working a treat for them both.

Do push your GP to prescribe a preventor. Failing that, ask for a referral to an asthma nurse or paed.