Ds1 (14) had an asthma attack at school

[Mrsmartell08]

His first one.
He was very anxious (obv) but used his ventolin to no effect and asked the receptionist to phone me
He looked awful :( and after 10 puffs of ventolin I rang the Dr who said to take him to a and e.
After x rays, bloods and ECG was discharged
Went to the Dr this morning and she has changed his preventer to symbicort twice a day.and we are back in 4 weeks.
Is there anything else we should be doing?
I'm a bit freaked out tbh
He has cough variant asthma and doesn't wheeze
His (great) paediatrician left 18 months ago and discharged ds at the same time
Should I push for.him to see.someone again?
Any thoughts appreciated

How scary for you both.
I would see how the Symbicort goes and ask for a referral to chest / asthma clinic when you go back for 4 week review if you still have concerns

Thank you

Your poor DS definitely ask for asthma nurse appointment, to confirm that he's using the inhaler correctly - it's fiddly. Keep a diary of symptoms for nurse to see - include stuff like coughing, wheezing, night waking, activity limitation due to asthma. Make sure he uses Symbicort religiously as this should calm down the inflammation - it would be the inflammation that caused your DS's attack (the attack would medically be termed an asthma exacerbation leading to hospital visit, or some such phrasing). Be on the lookout for any triggers such as pollen, dust, exercise etc, as these may make an exacerbation more likely.

I used to work in this area so PM if you need to!

Thanks very much
Quite cross really as he has a review 3 months ago and the Dr said yesterday that they no longer px his old preventer and thT his spacer stopped being used 18 months ago!
His dose hadn't Increased despite him growing a lot either
I'm not very trusting of the asthma nurse now tbh :(

Poor ds

definitely an asthma attack and not a panic attack? or both?

Yeah
Peak flow not great...
He is tired too nut I'm guessing that's normal?
It took.me so.long to get the Dr to take me seriously as it's cough variant asthma
He doesnt wheeze
Took years of him being really poorly before.anyone listened
His.lung function is 78% (or.was at his last testing)

The symbicort should help. I would definitely ask for a re-referral to Paed/Respiratory specialist (whatever it would be for a child). Just to keep him in the system really and to be sure he's on the right medication. A good asthma nurse can monitor etc but it presumably needs doctor input to get things in place. I would keep up with peak flow twice a day, before inhaler and maybe 20mins after. Maybe note symptoms etc if he has them as might show patterns and/or if they diminish as the symbicort kicks in (which might be a week or two).

Sorry meant to also say I agree about taking the symbicort religiously, even when he feels well.

Thanks

WRT to the old preventer, they may have stopped prescribing it to new patients for cost reasons rather than any other reason but continued for patients who are already on it. There seems to have been a bit of a switch over recently.

In terms of managing his asthma long term, use a peak flow meter if you have one and make sure he knows what symptoms he needs to be looking out for and might signal another exacerbation p. Things like night time symptoms, coughing more, needing to use his blue inhaler more frequently, needing to use more puffs of salbutamol than usual to control symptoms, finding activities that he used to manage more difficult etc.

All of these might be up in the air for a bit until the symbicort starts to take effect but should start to improve over the next few weeks.

Does he have hayfever? Hayfever can be a massive trigger for my DS1's viral induced asthma and so he's been on citirizene for a couple of years now between April and September. He's not been hospitalised since. for you - attacks are so scary. My son can go from being bouncy and fine to struggling to breathe between words and his ribs heaving alarmingly.

Thanks all
Yes he has hayfever but not badly. Has been on cetirizine since April but perhaps missed the odd day here and there
Did his peak flow this am and it was 400 :)
So the symbicort is working :)

Dr said old preventer now not px as it's been proven that it's not that effective?
I feel his last review in Feb was a waste of time and just a box ticking exercise
Can Drs do asthma reviews?

Which preventer and spacer did he have?

Glad the new inhaler is starting to help

Flixotide (sp?) acuhaler.
50 mcg x 2 puffs twice a day (was 1 puff until he got pneumonia 18 months ago)
Dr said something about too much of it (40%) being metabolised??
He is now on symbicort 2 puffs twice a day 100/6mcg

Hi op

Your DS may actually be better off as a result of this change; he was originally on ICS treatment only (i.e. fluticasone, which is the key component of Flixotide) but has now been put onto ICS/LABA treatment (i.e. Symbicort, which contains budesonide [ICS] and formoterol [LABA]).

ICS treatment reduces inflammation, while LABA (long-acting bronchodilator) treatment helps to keep the airways open so he can breathe more easily. LABA does the same job as his reliever, only the effects last longer.

Therefore your son should hopefully now breathe easier (literally)!

Hope so.
Thanks for all the replies x

Hi OP
Nothing to add to what's been said except that maybe you need to revise your emergency policy with the school so that they bypass you and go straight to the a&e option if this happens again (obviously they should let you know asap but not whilst gour ds sits there potentially getting worse).

Ds1 knows now if ventolin is not working it's a and e
The lady he will go to if it happens again is a severe asthmatic and so I think will be on the ball.
But I take your point.. .I might print off a form from.asthma UK
Thanks

Please do - agree an emergency plan with the school including a section on what to do if ds is too unwell to go in search of this lady.

I don't want to worry you unduly but there have been some terrible tragedies involving asthmatic kids at secondary school.

Asthma UK used to do credit card sized action plan things that DS could have in his bag or wallet to hand to someone. In addition to the written action plan school will need.

I know...its awful:(

I've found phoning the asthma nurse specialists at Asthma uk really excellent for help & general reassurance in the past.

Symbicort changed my life- from poorly controlled to barely noticeable.

I think that's my main worry...its been so well controlled for years
Only had issues when he got a URTI really
This came out of the blue
I do feel happier his meds are changed and upped
His peak flow was 400 this morning up from 310 on Monday so I think that's very encouraging that we needed to change his meds
I'm making sure he takes his antihistamine every morning too