Viral wheeze / ashtma - advice needed

[francohoops]

Our son who is nearly 5, had what we think is a viral wheeze this week. This is the third bout in the last 6 months. It starts with a cough/cold and then develops into a wheeze and he has to work harder for breath and his oxygen levels drop. He has been prescribed a course of steroids, montelukast tablets to take at night and takes a blue Ventolin salbutamol inhaler. Thankfully he is getting better.

The last bout was back in December. He has got through the past 3 months ok, having coughs and colds, but with them not escalating (we managed it with his blue inhaler).

Generally between bouts he is fine, not out of breath, no need for inhalers (unless he has a cold) – hence why I think he has not been given a brown inhaler.

The doctor is unsure as to whether it is asthma or viral. She is very thorough and would like him to take the montelukast tablets at the onset of a cold to stop it developing and going to his chest.

My concern is that may not be enough and we are just waiting for the inevitable next occurrence. The tablets may work, but I really hate having to give someone so young steroids when these bouts occur.

The doctor is confident he’ll grow out of it, which is good, but I don’t want him unwell any more than necessary, and these bouts mean a week off school at a time.

I’m thinking of pushing for a referral to a respiratory expert. The doctor’s view is to wait and see, but I’m thinking it would do no harm to get another opinion on this, and see if there is anything we can do to control it.

Does anyone have any similar experiences of this type of thing, and what would you recommend. I feel quite helpless. Hopefully the tablets are the answer but I’m not sure.
Thanks for your help
Frank

I'd be interested in the replies too as it sounds very similar to DD2. She's had three bouts in 6 months, two of which ended up with her in hospital as the blue inhaler wasn't working. She was put on Montelukast over the winter and has now been told to stop it "to see what happens".

Her viral induced wheeze also starts off as a cold/cough and I'm so nervous as to whether it will go on as an attack or it will clear up as a cold does.

Hi
Sorry to hear you're in the same boat.
How did your DD2 get on with the Montelukast? Did they work?
F

The little one I look after (16 months) often gets a viral wheeze and is given antibiotics and an inhaler. I also wonder if he has asthma

She's had one viral induced wheeze since on the Monteslukast - GP said it won't stop the attacks but it won't be so serious.

Having said that, DD2 had a bad episode last night so we ended up in A&E at 6.30am this morning, as the blue inhaler wasn't working to relieve the symptoms and she was still struggling to breathe. She was taken off the Monteslukast earlier this week, so don't know if that has affected her airways. But paediatricians at A&E have put her on it again for five days while her lungs are still sensitive.

Sorry to hear that.

Can I ask why they took her off Monteslukast? Did she suffer any side effects?

Have you have a referral to a specialist?

F

Montelukast isn't steroids.

My daughter developed asthma age 2 and was hospitalised 3 times. Montelukast has been an absolute life changer - she's been on it for 2 years now and had no attacks. I live in fear that GP will stop it. We are finally able to be in control of the asthma instead of the asthma controlling every minute of our lives. Asthma is very very serious. My daughter went from being told she was fine in the morning to stopping breathing 3 times later that day. Don't mess with it. If Dr recommends Montelukast take it. I nearly lost my daughter to asthma x

My understanding of Montelukast is that it interferes with the allergic reaction that an asthmatic May suffer in response to anything including a viral infection (ie a cold). DD, who has asthma and other allergies was on it for about three years. My understanding is that it needs to build up in their system to be effective, so introducing it at the first sign of a cold is unlikely to be effective.

Disclaimer - I am not a medical person, but the lack of a brown (steroid) inhaler in your regime also seems odd to me and I would suggest pushing for a referral. I am not convinced you are getting good advice.

Completely agree Ziggy. My DD doesn't take brown steroid anymore (thanks to Montelukast!) but we still have it prescribed in case of an attack. Maybe ask for a referral to a paediatrician xx

The doctor wanted her to come off it as it was initially prescribed for just the winter period. Now I'm wondering whether she needs it for longer. Will be seeing the specialist again at the end of April when she has her review.

But don't you hate the feeling of "will they won't they?" When they start having a cold/cough? I breathe a sigh of relief when the cold gets better on its own!

Since the end of November DD has been like this for a week out of every fortnight!! It seems to be triggered by colds picked up at nursery and is making our lives a misery. She's missing about 40% of nursery and the entire family barely sleeps as she's coughing and crying half of the night.

We've been told by the GP that at 2.3 she's too young for anything apart from the blue inhaler and will just grow out of it. I'm sure it's linked with her food allergies.

Montelukast is increasingly being used as the first line of treatment before going down the steroid inhaler route. Different doctors will have different approaches but it's not unusual now.

Thatsthewayitgoes - starting the steroid inhaler when there is an attack won't do much. They work by building up in the system so need to be taken all the time.

Pragmatic - your GP is lying. DS has been on preventative asthma medication since 6 months old. They may not like to diagnose asthma so young but they can certainly treat the symptoms and try to prevent problems.

DD1 was on the preventer from about 3 years old (nocturnal cough and from exercise), and is well managed now.

DD2 was on the preventer from about 2 years 9 months. But feels like almost every cold she picks up turns into an episode.

Please, please be aware that montelukast can have horrific side effects.
If ds starts to have nightmares, anxiety, tics, aggression etc please see your GP as soon as you can and wean him off them.
IME Drs don't tell you about the side effects and are very dismissive if/when you report them, putting down behaviour changes to parenting, but they can be life changing for some children.

IMO a steroid inhaler should be the first thing to try. Montelukast should be used under extreme caution and monitored very closely.

Here is a poster designed (iirc) by a parent of a child severely affected by monte, it outlines the side effects.

Sounds similar to DD2 - she has been on the brown inhaler for years now. It's a very low dose and she has been so much better. I can't remember the last time she used salbutamol and she picks up every cold going!

Don't dismiss the steroid too quickly!

DS, now 17, was like your little one. Every winter bouts of bronchiolitis, croup and wheezing, miserable nights..periods in hospital. Our doctor was sure he would grow out of it and he did, it decreased each year.
She said that the danger of labelling it so young is that it then becomes something to manage and follow up which then leads to more management 'just in case'.
Would it be worth discussing the implications of treatment with your GP?

My now-4 year old started getting viral wheeze when she was two. She was admitted to hosp three times in the space of 9 months or so before we were given any medication for her to have at home. She now has a brown inhaler (although isn't taking it at the moment) and a clear/green one as she doesn't seem to respond very well to ventolin. Our gp told us after one admission that montelukast is becoming the standard treatment for under-5s as they get better results from that than steroid inhalers.
It's looking like my dd may have outgrown it, we've got through the winter without needing any inhalers at all.

We asked our doctor for a referral to a specialist - she refused and said she'd prefer us to wait and see and persist with montelukast/blue inhaler at the first sign of a cold.

We got an appointment with another doctor at the same surgery on Friday - just initially to get their opinion, which was similar to our original doctor - but they were more than happy to refer us to a specialist.

My wife and I are a bit concerned that the specialist may start dishing out medication that we could do without - maybe we should have waited to see how things progress? We don't want a mis-diagnosis of asthma, just because we were pushing for a referral. Our son is five next month.

Should we go ahead and see the specialist?

F

I would see the specialist to see what their opinion is - they could agree with the GP. You could also relay your fears about additional medications (if any are suggested) and see what they say.

DD2 had another episode after coming off the Montelukast after the winter period at the end of March and had another episode (ended up in A&E again). Just so happens we had a review last week and the specialist has put her back on the Montelukast at the first sign of a cold.