Constant coughing in asthmatic 3yo - when to see doc?

[Gleek]

DD has had pretty much a constant cold since September, I have taken her to the docs once and he was fairly dismissive, kids get colds etc. She was diagnosed with asthma about 18 months ago although it's not an official diagnosis as they won't do this until older.

Tonight she has been coughing almost constantly for the last hour and fifteen minutes, to the point of retching/vomiting. She is also sweating buckets although doesn't have a temperature. She is taking about 35 breaths per minute which I think is in the normal range.

Would you get it checked out or just chalk it up to yet another cold?

How much ventolin has she had? What is normal for her in terms of night time cough?

She's had four "puffs" of ventolin. Normally she will have a little cough and settle herself down and once she is asleep she won't wake much, it's very unusual for it to be constant like this.

Bump?

I'd ring NHS Direct or your out-of-hours GP if I were you

They don't mind being bothered and would rather see you whenever you are concerned

Thanks KM, I am waiting for a call back now, she can't go more than 3-4 minutes without coughing/retching, poor little thing.

Hope she feels better soon. Did the ventolin help at all? If so may be worth giving her more while you are waiting

I would contact the doctor- actually, I am very cautious and therefore would probably go to A&E as by this stage I would feel a neb was required (hard to tell without being there). Those resps are at the upper limit for a 3yo and they tire very suddenly.
Does she have an expiratory wheeze?
DS has athma and ended upin hospital a couple of times at that age and younger when he had a cold which triggered his asthma to a degree not manageable with his usual inhaler.
Is she on a steroid inhaler or just the ventolin?

I spoke to the GP and he suggested 10 puffs of Ventolin every 4 hours which seemed to help. Rather typically - and thankfully - she seemed to settle after we'd called the GP.

I was very nearly just going to take her to A&E but DP always seems a little reluctant and it makes me question whether or not I am overreacting! I think in future I will go with my instincts, better safe than sorry. She has a preventer inhaler but only for use when she has a cold.

that's how I always feel Gleek- I just know with children how quickly they can go from managing to not managing (paramedic). I would speak to your doctor some more about the preventor, with ds we gave a larger dose during the time he was more likely to get a cold (winter mostly), as once it had started it was too late iyswim.

glad she's feeling better btw

I quickly learnt if in doubt with DS to take him to A and E, infact after the last bad experience with the GP his consultant told me to NEVER take him to the GP when his asthma is bad but to go straight to A and E instead.

Glad she is feeling better, i agree with looking at the idea of giving more regular preventor it can make a massive difference

We have been to a&E with DD for similar and shes had nebuliser and once steroids. Other times we have suffered through the night. Its a judgement call each time but HCPs have always said they would rather we had her seen than not. It seems as she gets older she is having less episodes but they escalate further faster. Also she is getting more and more distressed by attacks. Nearly never happens unless she has a cold or is coming down witha cold (cough sometimes first hint somethings up). She is 5 has been on preventer since 18 months.

she nearly never has an actual wheeze until quite bad struggling to talk etc. Its always an incessant hack hack cough with decreasing breaks between coughs.

Geek - just seen this. Hope your dd is better now. Just wanted to say, always go with your instincts and never think you are overreacting. We didn't, and dd1 ended up hospitalised with a very nasty attack. We felt as stupid as you possibly can feel, and if it hadn't been for a nice nurse calling us back on the phone to check dd1 was ok (she wasn't), it could have been an awful lot worse . Sorry, very gloomy, but don't want anyone to learn the hard way if you don't have to!

Thanks for all these posts confirming that it's better to get it checked out than not, it sounds like you've all had some scary experiences with it. I think as asthma is relatively common it can be underestimated.

We ended up phoning out of hours doctor last night who said we could give 10 puffs of ventolin as often as we needed and we did this a couple of times and it seemed to work.

I am taking her to see the GP today as I want to check it's not a chest infection and that we're managing it ok. I am also wondering if she is old enough to do a peak flow? She really hates having her inhaler, it is such a battle that she ends up crying so much that it makes her asthma worse, a bit of a vicious circle.

Have you tried letting her play with the spacer to get used to it? Pretend to give yourself inhaler, toys inhaler etc

Also what spacer do you have? I found the smaller one much better for Ds

Just read this, and wanted to say that preventer inhalers can take a couple of weeks before they are working properly, so just taking it when she has a cold won't help her.
Hope she's feeling better soon :)

Hmmm, our consultant always said that if dc needed the full 10 puffs every 4 hours to keep it under control, then we should be taking her to a&e to get checked. Not sure it's a recommended long term management strategy! Asthma uk is a great organisation, with a good website and helpline if you want to talk through management a bit more.

No, I don't think they are old enough to do peak flow until well into school age from what I remember. Agree with the letting her give the spacer to her teddies first etc. We always used to count silly things as well - eg 1 elephant 2 bananas etc until the slow count of 10 was reached, or she could choose what the counting theme was. Basically trying to give her as much control as possible. Sometimes though it was easy way or hard way, and if she was being a monkey and chose hard way, then we had to pin her down to do it. Sounds harsh but better than having another full blown attack again.

Lukewarm we were told the same, as soon as we have to give 10 puffs he has to go in, or if 5 puffs lasts less that 2 hours

Sounds like she needs to be on her preventer daily, I get a cough (not cold or flu related) and it is usually a sign I need to change my meds or when I have ran out of my preventer! I don't take a preventer all year round but usually over winter I am.

How about putting stickers on her spacer or giving her a sticker to put on her spacer each time as a kind of asthma related reward chart? Really tough and scary for you. :(

Just realised I called you Geek op. oops sorry!

No worries lukewarm, I wouldn't take geek as an insult anyway

I thought she was on a preventer but apparently it wasn't, it was a type of inhaler they give to little ones, a milder type of inhaler - I can't remember the name. They prefer not to give preventers to under 5s but we're going in to see the specialist paediatric GP who is going to make a call on it.

Turns out though that she did have a chest infection so we now have amoxycillin and a few new inhalers for home, nursery and carrying in my bag.

GP confirmed what you've all said really, if we need to give 10 puffs then it's at the level where we should go in and don't hesitate, impossible to tell what the 'tipping point' will be from manageable to an emergency. Echoed that three year olds tire very quickly and it's better to be safe than sorry.

GP also gave us a small spacer which has teddies on it (before she had really big clear ventolin spacer) which she took happily this evening so a very worthwhile GP visit. Thanks again for all your support and advice!

Atrovent?

Not giving preventers under 5s sounds like rubbish to me, DS has been on one since 12 months and is currently on the highest dose for an under 16 plus another preventor medication ad he is only 2.2. I know plenty of under 5s with much milder asthma who have them to so if he is having regular problems I would really push for that.

Those spacers are much better, hopefully that makes it easier and she feels better soon.

Yes, I think that is it, white with a green cap?

That's good to know, whilst this GP was great and really helpful she wasn't massively confident and had to Google ages for preventers so it's possible a doctor with more expertise in this area may think differently.

I'll def push back on them a bit at the next appointment, I would just like to have one for winter. DD is fairly typical asthma kid I think as she suffers from hayfever and eczema but they still have the reluctance to 'diagnose' and I think that the preventer is part of a wider diagnosis - as I understood it anyway!

Glad you've got somewhere, hope the abs kick in soon and she feels better.

Agree that the 'no preventers for under 5s' thing sounds odd, dd's had hers since age 2, and there are plenty of others with young dcs round these forums with the same. The dosage just varies with age, but if it's needed... The paed might give you a bit more specialist guidance.

Good news on the spacer too, dd preferred the teddy spacer as well - its smaller and it's got teddies, what's not to like?!