just found out my 3 year old has asthma and I feel so clueless

[TiredFeet]

We saw the consultant the other day as a follow up from my sons hospital stay for severe bronchiolitis and she has told us my son has asthma. He was given a preventer (clenil) and reliever (salbutamol) but his bad night time coughing means he is also now trying granules.

I feel so clueless, I wasn't there when he was discharged from hospital (as I was in hospital myself!) So thought the inhalers were just for the bronchiolitis recover. I wasn't expecting the diagnosis so didn't manage to think of all the questions I now need answering. I also feel guilty it wasn't diagnosed sooner, he's had the bad nighttime cough since he was a baby. But I asked so many drs and they were dismissive. Apparently his chest hasa classic 'shape' for a child with asthma, I am worried that means we've done damage by the delayed diagnosis?

Also, I don't feel at all confident to know when I should be giving his reliever.

And he has a bad cold and sore throat today, should I be worried and go to the dr/is there anything else I should be doing.

Really struggling, I am so used to feeling in control of his allergies and eczema and this has thrown me.

Right first things first This is not your fault , Asthma isn't generally diagnosed in children under 10 I think it is .

My Ds has Asthma & was diagnosed at 2 months .

Firstly when he is in bed/ cot prop his head up with a pillow either under the mattress or on top to aid his breathing .
His reliever should be given when he is coughing or seems out of breath & the brown inhaler say if he is to have it twice a day do it first & last thing , The montelucas (sp) mix it in with a yoghurt its the only way my Ds would have it .
Lots of ice lollies for the sore throat & for yourself .
You will soon get in to a routine with the inhalers/ montelucas etc & you will pick up on the signs , Have you been reffered to the Asthma clinic as they are very helpful , I think I have covered everything if I haven't just ask
Oh and too much of the blue inhaler can make them hyper .

Also when Ds is bad I have a routine where I stick him in a bath with olbas oil & then cover him in Vicks it works a treat

First of all, please don't beat yourself up. Asthma is quite difficult to diagnose in littlies, but is also very common. What is great is that your DS has a definite diagnosis and management plan. What is also good is that if they get a definite diagnosis at such a young age, they are highly likely to grow out of it by the age of around seven or eight years. Trust me, I'm a healthcare professional and writer, and also have a dd with asthma, so I am not just spouting.

Now onto the management. The preventer (clenil) needs using everyday. It is the best thing to keep the symptoms at bay, and please don't fret about using steroids. Because it is inhaled, the dose is actually very low and is highly unlikely to have any effects on the rest of the body, though your asthma nurse at your go surgery will probably keep an eye on your DS's growth just to be on the safe side.

The reliever (the blue one) needs using whenever he is wheezy or if he is coughing a lot at night as this is a sign that the asthma isn't under control. At the moment, you may be needing to use it quite a bit but as the preventer starts taking effect, it should start winding down quite quickly. You can also use the reliever as an acute, when needed, medication if he gets really wheezy or breathless. 10-12 puffs is the same as having a nebuliser, though obviously get him checked out if you have to do this.

If you are having to use the reliever a lot on an ongoing basis, go back to the doctor because the clenil dose might need increasing.

Do you have a spacer device? This will ensure he gets the drug into his lungs without having to learn the slightly tricky inhaler technique. He can just breathe as normal through the spacer and the drug will get where it needs to be. You can use it for both the reliever and preventer. Wash it once every couple of weeks and allow it to air dry.

A little tip is to use the reliever before the preventer, as it opens the airways and allows more of the preventer to be absorbed by the lungs. You won't want to do this forever but at the moment it may be a good idea as he has been so unwell.

How does that all sound?

Also if you are concerned take him to your Doctor that's what they are their for

Don't beat yourself up. He has actually been diagnosed young very few children are diagnosed under 4. DS was diagnosed at 11 months by a consultant and our GP actually argued he couldn't be asthmatic as he was too young.

There is a lot of trial and error in knowing what triggers each child and when they need blue inhaler. If he seems to be struggling at all then give him a couple of puffs and see if it helps. It is normal for it to be worse at night and you may also find exercise, illness and weather conditions could make it worse (but again they may not!)

As you mentioned allergies you may not that may be linked too so when he is having a reaction it may make his asthma bad.

Don't beat yourself up with the late diagnosis. My dd was 4 and diagnosed after a 3 day hospital admission after I rushed her there with lips starting to go blue. I thought she had a bad cold

Give the preventer meds as instructed, I was told that they can take up to 2 weeks to reach full efficacy. I'm not familiar with the reliever your DS has, but you should be able to find out what is considered to be the "maximum" amount he can be given before escalation to GP/A&E. I give the preventer whenever my DD has a wheezing sound when she exhales fast. Also you will notice your DS will breathe with his tummy muscles rather than his chest muscles when he is struggling.

My DD's is seasonal allergy related and also after respiratory strain (running round like a wild child a bit more than normal). The ENT specialist we saw suggested that keeping my DD's upper respiratory airways cleared and well managed will help to manage the asthma symptoms - and it has. When she has a cold, I'm militant about nasal sprays (medicated ones twice a day and saline every hour or so).

It's taken me about 3 years to really feel that I've got this under control. I started out like you, not sure how/what/when. Hang in there

Thank you this is all very helpful!

I will try the reliever before the preventer for now

He has a spacer.

Should I give it every time he coughs? Just if he coughs lots? Sorry if that sounds stupid!

I don't know if I would recognise a wheeze. His nursery sent him home one afternoon as he sounded wheezy, and the gp agreed, in fact he was so bad the gp gave him a big dose of oral steroids (pred), but I really couldn't tell. Doesn't help that I have a newborn so my brain isn't really working!

We have a review with the consultant in 4 months time. I just wish I had even once googled night time coughing, but I was so busy getting to grips with his allergies and eczema, plus dh can make me feel like I am being neurotic about things!

I tend to give it if the cough doesn't settle with rest (if in the day) or if it keeps going at night.

You will find you soon learn to pick up when things aren't right. But when you get the preventer medication correct you shouldn't need to use as much ventolin anyway as it should help control things.

Make sure you get another ventolin inhaler and spacer to leave at nursery incase it is needed.

Thanks Sirzy, that's really helpful. I think the problem is that he has had asthma undiagnosed for such a long time that it is just 'normal' for us if that makes sense.

Interesting about the saline spray MissusMck, we used it a lot when he was younger and it did help, but he kicks up a big fuss about it now but I will try and persuade him!

My dd is not a fan of the nasal spray either. Then I remind her it's this or the hospital. She soon saw sense
Re yiur comment to use the preventer before reliever...is your preventer not a daily dose regardless of symptoms? My dd takes 1 puff twice daily of her preventer and it's job is to keep the asthma symptoms away, and we only use the reliever if she is shiwing signs of distress. Initially that was often but now it's maybe once or twice every couple of months

Yes, the salbutamol should be used if the cough seems persistent. My dd tended to need hers at night (classic asthma), when she had a cold and during the summer when she developed hayfever. Asthma can have a large allergic element, so keep an eye on it.

As for the wheezing, put you ear to his chest. You'll hear a rattle. At her worst, I could literally hear my dd breathing in another room :-( But let the cough guide you as to how well your DS's symptoms are controlled as that seems to be his thing.

I second the advice about having spare inhalers and spacers, but at home as well as at nursery. Nothing worse than running out or leaving one somewhere and being caught short.

By the way, do you give ibuprofen liquid to your DS? Worth considering that it can be a trigger. If he hasn't had a problem with it, then it is fine and is unlikely to cause a problem in the future, but just be mindful of it and use paracetamol instead if you think it may be causing his symptoms to flare up.

I second the advice about having spare inhalers and spacers, but at home as well as at nursery. Nothing worse than running out or leaving one somewhere and being caught short.

This got me thinking we currently have inahalers (and spacers)

• In his bedroom (out of reach as he is only 4)
• In my handbag
• In my mums handbag (she does a lot of care)
• At nursery (plus a spare inhaler)
• In the car boot

I also have 2 boxed ventolin inhalers as spares for when they run out. I do rotate them though as the nursery and general home one get used more than others so I check the others to make sure they aren't going out of date.

Some brilliant advice here:) I'm in a similar situation with my son who was recently admitted with viral induced wheeze, DRs won't diagnose asthma because of his age (4.8) so I missed how unwell he was becoming until he was admitted for steroids :(

Been seen by respiratory nurse at local hospital as DS has hay fever so having allergy testing and see where we go! Only have a reliver inhaler but been given a really useful traffic light leaflet on when and how to use inhaler, when to increase and get help etc.

I found my GP nurse useless in caring for my son I had been shown completely the wrong inhaler technique so obv not get full effects of meds.

OP hope you are feeling better with the fab advice from other posters I have found it useful asthma association website really useful.

Lily - even if they won't formally diagnose asthma they should still provide a preventer inhaler if his symptoms are bad/consistent enough he is needing regular ventolin.

Thank you, you are all brilliant! I feel a bit better already thanks to you lot

Tired glad you are feeling more upbeat. It's a pain to have another thing to deal with as a parent, but it's far better to know that it's asthma and have your DS in the system and being monitored than otherwise. He'll be eligible for the flu jab each winter (assuming the childhood programme that is currently rolling out doesn't include him anyway), so make sure you remember to do that if your surgery doesn't issue reminders!

Onwards and upwards...

Oh, and as a final note, if any of you have issues with your DC's asthma medication including inhaler technique, pop into your local pharmacy rather than seeing your GP. No appointment necessary and they (we) really do know an awful lot about this kind of thing so should be able to help

Sirzy, thanks for comment I did mention this but they said they would rather allergy test him than start him on meds now, they are hoping that we can identify and eliminate triggers, I will however keep this in mind, although my DS only has symptoms related to a cold/ hay fever and my understanding of preventers is they are taken daily as he is ok most of the time I guess a preventer is not require at present. Thank you though :)

Can I ask does anyone know whether my son is able to access flu jab without a formal asthma diagnosis ?

Lilyben my DD has had asthma since she was a toddler and has had the flu jab every year. If your DS has a viral induced wheeze then that is a long-term respiratory disorder and so at our doctor's that would qualify.

I think it's only if they have a preventer inhaler they get to flu jab?

Although I think the intention is to offer it to all children?

Thank you I will speak to the respiratory nurse at next months allergy test :)

TiredFeet - it might be worthwhile seeing if either the hospital or the GP have an asthma nurse who can draw up an asthma plan for you.

It sets out a plan for giving the reliever and what symptoms to look out for.

I'd also highly recommend giving Asthma UK a call. They have a free advice line staffed my nurses who are greatfor answering questions whilst you're getting your head around it all

Hi OP.
My son has mild asthma,we see asthma nurse every few months.
I often can't tell if he's wheezy or mucasy (made up word!).

TheGP will always see them though if you are worried.
My son usually only gets wheezy when he has a cold.
Loads of good advice on here!