asthma? how should it be managed?

[penguin70]

DS2 has had a cough since before Christmas last year. He had lots of anti- biotics to no effect and was referred to hospital several times but none of the drs were interested and put it down to virus.

Cough got better over summer though never went completely and came back bad as ever a few weeks ago. GP made another appointment with a consultant and this time got one who seemed much more interested. DS2 was put on 100mgrams salbutamol 4 puffs 4 times a day for 2 weeks. It's made a big difference though cough still not gone completely. Does this mean asthma?

The 2 weeks is almost up and I've called to see if /when we're getting another appointment. General secretary has had a word with Dr who told her that we should continue with puffer and get a new prescription from GP. Queried another med that DS2 is on and am waiting on a call back from Dr's sec on that, but it sounds like that's the end of the consultants interest in cough. Should I push for another appointment? Doesn't feel like the matter's properly resolved- I keep giving blue inhaler with no brown? Already on a much higher dose than the instructions say ...I really carry on indefinitely at that amount?

GP has already said practise have limited knowledge of children's respiratory problems (part of the reason she's been great in repeatedly get him seen at hospital) - will they now take over trying to get asthma sorted or should it be hospital?

Any advice appreciated !

How old is he?

Not that it makes much difference to the treatment, but if he is under 4 its unlikely you will get a confirmed diagnosis of asthma.

Blue inhalers shouldn't be used long term, they are designed to relieve the immediate symptoms. As you said he ideally needs to try a brown inhaler (or other preventer medication) and see what effect that has. A controlled asthmatic shouldn't need to use salbutamol more than 3 times a week.

I would make an appoinment with the gp to discuss what is best for him.

Can't really say how to manage it without knowing what his asthma trigger is - for eg, mine are dust and perfume.

But, to the best of my knowledge: A persistent cough being dx'd as asthma would suggest mild asthma (think of it as a constant slightly swelled throat, as opposed to the throat suddenly swelling up in response to triggers - these have to be treated differently and are not the same), in which case you would use the blue inhaler at the recommended dose and then cut down as the symptoms are abating, with the aim to stop using it totally and only restart if the symptoms start again.

I think you really need to go back to the GP and find outmore details particularly if it is mild asthma or regular asthma.
And what the situation is with regard to how often he should be having puffs and for how long.

x-posts!

Asthma is very individual. I'm not sure you will be able to see the specialist again but GP might have more details from medical notes/letters on file.

Thank you so much for all the posts

sirzy DS2 is 9 and had perfect health till cough started I think with a virus originally (I had a bad one that I assume he caught but mine cleared in a week).

TeWihara He's never wheezed that I've noticed but without inhaler coughs pretty consistently (apart from at night which I know is strange for asthma)- can't think of anything that triggers it off.

Now that he is on his inhaler I noticed that he coughs more when running about but it's not an attack as such like I've seen other people suffer. If it is triggered by something how long would the trigger have an affect? Would a skoosh of perfume make him cough for 1 hour...2...3? I know everyone's different and probably impossible to say, just wondering.

Natashabee did they still think asthma but just treat differently? Is singular a long term treatment?

Can I expect the cough to go completely when asthma is managed properly? I know small children can grow out of asthma but what if it starts later? Do you think there's a chance?

Thanks again so much!!

From what you have said, I think your son has mild asthma, it may well be totally impossible to find out what the trigger is in that case because you're not getting an immediate reaction, although it could be exercise related possibly if he's coughing in the day but not at night - that doesn't mean he should stop doing exercise though, there are ways to manage asthma in those circumstances though it's not a trigger for me so I don't know the details!

this is the NHS asthma page, not sure if this might help answer some of your questions?

I would think if it is mild asthma that your DS cough will disappear completely if you keep up the blue inhaler, once it is gone you should be able to stop using it. However, keep in-date inhalers in the house in case it happens again as asthma can come and go. If the blue inhaler doesn't work they will probably move up to a brown one, which contains a different type of drugs and works slightly differently.

It's hard to say if children can grow out of asthma, both my sister and I developed asthma fairly late (she at 7, me at 15) and haven't had any symptoms since early 20s, but it can flair up at any time so it's best to be prepared just in case.

I think it's a good idea to go back to your GP and check you've understood everything correctly, bring up any questions with them. Or perhaps write to the specialist for clarification if you won't be able to have an appointment with them again?

Thanks TeWihara

Asthma was never actually talked about at the last appointment apart from at the end when the inhaler was prescribed. Because he doesn't cough during the night and it doesn't sound like an asthma cough I think inhaler was given as a last resort to rule it out rather than treat cough if that makes sense. After 10 months+ of coughing I was quite happy to try it and so happy its worked but now have heaps of questions.

Think Dr called when I was out so hopefully he'll call back again tomorrow and I can now ask more informed questions

Singulair is a long term treatment, I'm an
Adult so different but I'm on singulair, salbutamol, fostair, uniphyllin and salbutamol and still struggle. the singulair doesn't really do much for me but I can't breathe without the uniphyllin.

Ah I see, I was wondering why they had been so rubbish explaining!

That NHS page is really good for explaining the details, and now it seems to be established that it is asthma I'm sure they'll be happy to help you come up with a more detailed care plan.

Sorry you have such a tough time with asthma hayleysd - don't think DS will be so difficult to treat.

Thanks again TeWihara - have read a lot of the pages you recommended -v informative. Will read rest before bed.

If he's 9 he is able to do twice daily peak flows and keep a diary of the readings. If there is a significant variation between morning and evening readings across a fortnight then it can be a diagnostic tool for asthma.

Persistent cough can be a symptom of asthma, but in older children can also be accompanied by chest tightness, shortness of breath especially on exertion and occasionally wheezing. If he is getting good relief from the salbutamol certainly continue that but if you came to see me (asthma nurse) I would ask you to do twice daily peak flow readings, and then depending on the results start him on a low dose of inhaled steroid and see if that improved things.

Salbutamol alone won't reduce any inflammation in the airways if he does have asthma - asthma is an inflammatory condition and needs anti-inflammatories eg steroids to achieve good lung function. It is used more for symptom relief.

Thanks Sidge I would love him to have a proper test for asthma, still a bit of me that doesn't believe it is, he doesn't tick the normal boxes but inhaler is relieving cough a lot.

I still haven't been able to speak to hospital Dr and GP doesn't have letter from him yet so in limbo at moment.

Thanks so much for all your replies.

Eventually got to speak to hospital Dr at 7 last night - still not convinced its asthma. DS2 wil continue with blue inhaler till Dr receives more advice from Sick Kids (specialist hospital in Edinburgh) which hopefully will be soon.