Wheezy - would you go back to the brown inhaler?

[Grammaticus]

DS1 is ten and was given a brown preventer inhaler when he was five, following a night time attack when he was very short of breath. He has had a very low daily dose of it since then and been monitored by the asthma nurse at our GP practice. He has needed his blue inhaler only on a handful of occasions each year. He has never had another attack of the first sort.

We have never managed to get him off the brown inhaler because each time we have tried he has developed a persistent "her-hum" sort of cough and we have put the dose back up.

He also suffers from hayfever, as do I.

A month ago we took him off the brown inhaler. His peak flow was 200 - 220 when he was on it, and has remained at that level since we stopped.

He now has a cold, a mild but frequent cough and a wheeze (which is unusual for him). His peak flow is 210. He has used the blue inhaler but is still wheezy, though coughing less.

What would you guys do?? Do I restart the brown inhaler or hold out and hope that the cold will pass and he will remain inhaler-free?

Jajas - our GPs are now offering to put regular prescriptions on 'auto-repeat' - which would mean that I would only have to remember to go and pick it up - without waiting 48hours.

All I have to do now is remember to ask them to do it

WilfSell - I only (ATM) know adult asthma, but I am fairly sure that every practice should have at least a share of a specialist asthma nurse - have you tried asking the receptionist/ practice manager?

Three weeks doesn't sound like long enough to actually allow the brown inhaler to do it's work. From what I know of inhalers it can take up to 6 weeks to really make a difference to the airways.

Hayfever is beginning to kick in though so that could explain the coughing yesterday.

My GP practice has a dedicated asthma nurse who deals with all asthma referrals (she works alongside one of the GP's who is a chest specialist). My experience is that lots of GPs know bugger all about asthma and that anyone who presents with a-typical asthma symptoms throws them completely.

Thanks all.

In fact I've just rung the surgery reception as suggested. They told me that one of the nurses is their asthma specialist and sees all the kids with inhalers.

So why the GP didn't know this is a bit of a mystery.

I'm taking DS2 in this afternoon for a review! I will ask her if the 3 weeks on/off thing is actually a good idea or not.

Thanks - your advice spurred me into action.

I was told by GP and asthma nurse that the brown (preventer) is the most important one and should not be stopped. The whole point is to use the brown one effectively so that the releiever (blue) is not needed. If you get to the point of needing the blue one, the brown one is not working - either because you are not using it correctly/sufficiently or the dose is incorrect.

Some children get worse when they have a cold, or because they are allergic to pets/house dust/tobacco smoke, or because of hayfever (which can start as early as march), or a combination of all these factors.

I have never come across a nuse or GP advising stopping the preventer. Some GPs/nurses know very little about asthma management - it requires specific training.

Hope you manage to get it all sorted out. Asthma in small children can be very scary IME.

How did you get on WilfSell? Doing 3 weeks on and off sounds a bit bonkers to me, as it takes 3-4 weeks for the brown one to really show an effect. Just as it's beginning to work you would be stopping it!

However it is possible to advise patients to stop their brown one, eg some children (and adults) have seasonal asthma so you might advise that they take their inhaled steroid between say September and March, then reduce and stop it over the summer (or vice versa). But it would depend on a thorough assessment and knowledge of that patient's asthma, with a history of seasonal effect so you would only start doing that if you had been seeing them for some time and knew their triggers, seasonal response etc. They would also need a comprehensive management plan with very clear indicators of when to return and be reviewed.

It's true that many GPs are pretty clueless about asthma, as their practice nurses do the bulk of the asthma care and tend to be the ones to do the diploma.

Thanks sidge (and all). Turned out the practice nurse seemed to know more about it than the GP so perhaps she has had more training. She confirmed that 3 weeks isn't often long enough and suggested both that we go back on it, since he'd had a horrible cold during the first period so difficult to assess whether he was really doing better on it. She asked about peak flow readings and I said we'd never had one done. She said it can be difficult in smallies but she would usually give it a try. Now he'd just been jabbed in both arms anyway so he was in no mood to go anywhere near her. But she suggested back on brown and then review in a month. She just gave me more confidence TBH.

I must say I'm still hoping he'll grow out of it as his older brother did by about this age. This is why I'm reluctant to accept the diagnosis of asthma. There's no asthma or eczema or particular allergies in the family, and this started as a post-viral problem in both children.

But equally, I don't want to risk the night cough getting worse or having lasting consequences for his growth etc. But I do want to get to a point when we can really know that the brown inhaler IS the thing that is making the difference. Or not.

Thanks for asking.