Hayfever? Asthma? Ventolin? Advice / reassurance please?

[Frieda]

DS has suffered from hayfever since he was three and it reliably seems to peak during the first week of June - symptoms include puffy, itchy eyes, runny nose, sneezing, etc. This year (he's seven) his hayfever has been bubbling under for a good few weeks and I've been treating it with Clarityn (as a morning preventative) and Piriton whenever the symptoms worsen, which has been doing the trick up until now.

Yesterday afternoon, it suddenly started getting much worse. His eyes puffed up like golf balls, went itchy and pink and he said his throat hurt. I gave him some Piriton, but it didn't seem to get any better, and by bedtime he was coughing and sneezing, too. He finally managed to get to sleep by about 10pm, but when I came up to look at him his breathing was really laboured and he was making a sort of wheezing noise.

To cut a long story short, I took him to the doctor's this morning (still wheezing, racing heartbeat and no energy) to be told he had asthma and needed a ventolin inhaler on an hourly basis and could take up to 10 puffs at a time if it got bad, and I wasn't to be afraid to dial 999 if things got really bad. He's actually quite a bit better - not wheezing at all at the moment - but I'm obviously quite shaken and worried about all this. The doctor seemed a bit vague about how much ventolin to give him and how long to go on giving it for - didn't suggest a follow-up appointment - and I was concerned not to show too much alarm in front to DS, so stupidly didn't pin her down (I'm planning to go back to the surgery tomorrow to talk about it, perhaps without DS).

We have no asthma or exzema in the family and I've no experience of using ventolin before - the amount the doctor is suggesting I give him seems a bit alarming (especially as it says in the information on the box that eight puffs a day is the maximum recommended - she's recommending 2 puffs every waking hour and 10 in extremis). What exactly is ventolin and is there any worry that it cause long-term damage to the lungs?

Sorry this is so long and rambling, but does anyone else have any experience of this? I'm hoping he'll get better once the hayfever season is over (sadly, they've only just started cutting the silage round here ) but don't want to unneccessarily overmedicate unless he really needs it. Meanwhile, he's obviously suffering quite badly - wheezed like an old man after running a very short way down the garden this evening .

Thanks in advance for any contributions.

my ds has been the same since a baby. always flares up with hayfever - live in the country.
you should maybe use a preventor - becotide or similar. must be used regularly as prescribed. ventolin is a reliever and works quickly on wheezing - opens airways. have been told the same - if it gets very bad just keep using it until it calms down. not aware of long term effects, but is only used for very short periods. ds is now 14 and isnt effected much by asthma, meds dont appear to have had any bad effects, is fit and healthy otherwise.
hope ds soon improves,

I agree
would go back to drs and request a preventative spray becotide or low dose seretide meanwhle if ventolin is providing relief do not worry that is what it is meant to do
hope his asthma is seasonal please do not worry too much been here with a toddler who actually grew out of it she is 12 now
allthe best al4gz

Thanks for that, singledad - its helpful to hear about your experience and I'm heartened to hear your ds has come through it all unscathed! I'll ask about the becotide.

We live in the country, too, which is otherwise lovely - just a trial for poor old ds this time of year.

Thanks all4girlz, too. We're obviously not alone, although it's scary to see your child struggling to breathe, isn't it? Must have been even worse with a toddler - poor you, but glad to hear all ok now.

seems so long ago since ds was really bad with it, but some nights i had to sit with him and 'breathe' with him. they can hyper ventilate which closes the airway and causes them to hold their breath as it hurts to breathe. you've got to listen to breathing when it happens and help them correct it, takes patience but does work. they get very tense with it all and can be scary to both of you. sure you'll be ok - could always live on a scottish beach...brrr.

Use the ventolin - but it shouldn't take 10 puffs! I've had asthma for 20 odd years & have never needed more than 4 or 5 - & I have Becotide prescribed too. If your ds is struggling to that extent I'd say he needs to go to Asthma Clinic (our GP keeps HASSLING me to go - they get extra funding for it I believe), where they'll check how severe it is with a peak flow meter & possibly prescribe preventatives such as Becotide.

Your GP should be being a damn sight more helpful IMO - my asthma went undiagnosed for a couple of years & it's terrifying & quite unnecessary. The hayfever season makes it much worse for some people, unfortunately - I'm not trying to be alarmist, but if it's not monitored & treated it can cause frightening attacks (hospital & oxygen masks) or worse. Definitely go back & discuss it further with your GP!

Don't worry too much about over use of Ventolin BTW - if he needs to use it to relieve his breathing he should do - but yes 2 puffs an hour seems a lot & I'd've thought would indicate use of a preventative as well as a reliever.

Sorry - looks like I x-posted with everyone else!

If he needs an inhaler on an hourly basis, he should really be in hospital.

As a rule of thumb, if you need to use the inhaler more than 4 hourly, you should see the GP, and more than 2 hourly, then it's A&E.

Thanks Olivia and scienceteacher – I think I need to make an appointment to see another doctor.

Thanks Olivia and scienceteacher – I think I need to make an appointment to see another doctor.

yes go back asap and if you can't get an appointment for a bit, ask to see the asthma nurse straight away. They are normally very good at explaining asthma and are very patient with children - if he (or you!) has never used ventolin before, he probably needs a demonstration as to how to use the inhaler properly just to make sure he is doing it right. The asthma nurse is very good at that sort of thing.

GeorginaA may be along in a minute, but I'll see if I can look up the asthma help line - she normally recommends them and I believe they are very good.

We find that since dd has been on the becotide as well (a brown steroid inhaler), her hayfever symptoms have been far better than they used to be.

Thanks foxinsox. This is all new to me and this kind of info is really helpful.

F x

I think this is the one she recommends.

\link{http://www.asthma.org.uk/applications/new_to_asthma/form.rm\asthma uk}

Thanks again, foxy. Just been onto the Asthma UK helpline and they agree that hourly ventolin sounds a bit heavy. Can't get an appointment with the asthma nurse until the 15th (!) Tried to get another doc appointment but fierce receptionist is being difficult and will only agree to getting the practice nurse to ring me to assess whether I can see the emergency doc this pm .

how ridiculous

why are you made to feel like you are the one causing the problem?

make sure you tell the practice nurse what's going on - hopefully she/he's sensible and will see that you really do need to see the doc

i haven't read the whole thread yet so not sure what others have said but i would be very unhappy with that doctor. your son doesn't have asthma, he has hayfever, which should be treated with antihitamnes etc, has he been offered the injection?

i had a similar experiance with doctors when i was 3 or 4, they wanted to put me on asthma medication for a chlorine allergy. luckily my mother had sense enopugh to see what was really wrong and took me out of swimming classes with miraculous results but the doctors tried to accuse her of child abuse for not taking the medication!

10 puffs a day is a highly excessive dose of ventolin either way, especially for a child. ventolin should only be used when an attack is coming on, not as a preventer. there are preventer inhalers like beclazone available which can be taken morning and night to help prevent attacks, and if you really believe your child has asthma you should consider reading a book on the buteyko methods as they are extremely effective, especially when learned young. my dp has had asthma (not an allergy, proper asthma!) since he was 8 and was having asthma attacks almost every day of his life, on beclazone and ventolin for years. since learning the techniques his asthma has improved radicaly, he no longer needs the beclazone and he hasn't used hid ventolinin weeks.

HTH, and seriously consider changing doctors!

Hi there

Managed to get an appointment this afternoon via the practice nurse with another doc in the practice. Even she seemed a bit surprised he'd just got ventolin and not preventive medication. Original doc rang me back afterwards to assure me 10 puffs was ok and they often give over twice that in hospital. I tactfully explained that I just wanted some clarification and more info about preventative measures, and she agreed another appointment wouldn't be a bad thing. Thankfully, there's a different duty doctor on this afternoon and I think he has a special interest in asthma, although as you say, pinktulips, I do think it's definitely allergy induced hayfever rather than asthma, but it's affecting his breathing quite badly. In any case, they do need to look at the cause and treat that rather than just dose up with ventolin.

Thanks everyone for your input - especially the asthma helpline, which was v helpful.

hope it goes ok - poor ds (and poor you)

hope it goes well, big {{{hugs}}} for your little lad btw, sounds like he's having a seriously rough time of it

we started off with ds just needing a few puffs of vetolin. When this wasn't giving him enough relief, and we were using it more than twice a week, he was put on a steriod inhaler.

Now we only need the steriods in the winter months, seldom if ever used the blue reliever, and his peak flow is perfect for a child of his age and size.

The blue reliever works by relaxing the muscles in the lungs, and so 'open up' the airways.

I find that seeing the ashma nurse in the practice is normaly more helpful than seeing the gp....and I have a very good gp!

just to clarify- it is perfectly safe to give ventolin 10 puffs an hour to a child with asthma, BUT if your child needs 10 puffs an hour then he/ she should probably be on a preventer on a regular basis.

asthma can be triggered by allergies,and can happen simultaneously with hayfever, so they are not entirely separate entities. If the antihistamines haven't worked, then ventolin is a reasonable treatment, BUT prevention over the summer months with a steroid inhaler would be preferable.

They do give higher doses of ventolin in hospital, but it's done under supervision, and it's done in conjunction with other drugs.

It doesn't really matter what the cause of the wheeze is on the day - it needs to be treated with ventolin (and oxygen, possibly), and/or one of the other bronchiodilators. Preventative treatment will be according to the trigger (hayfever, virus, exercise, etc.).

I do think that giving a patient the instruction of 10 puffs an hour doesn't seem right. They should be monitoring SATs at least, and if they need that much relief, they should be looking at a combination of drugs, such as Atrovent & Ventolin, as well as emergency steroids (eg prednisolone).

The question is, does the treatment you were told to give seem to be working? Is your DS better now, or is he still giving cause for concern? What medicine is he actually getting, assuming you are not actually going up to the maximum recommended dose?

You can't really assume what the trigger is if this is his first wheezy episode, even if it coincides with the hayfever season. I don't think you should automatically go onto preventors after the first attack.

Thanks tissy, martianbishop and scienceteacher. We saw another doc this afternoon and he's been prescribed Flixotide, which I think is a low-dose steroid in conjunction with the ventolin, which he tells me we shouldn't need to be using any more than 4-5 times a day, unless ds has a bad attack. We've got a follow-up appointment in a couple of weeks to see how he's doing. Doc was really patient and explained how both medications worked and made sure ds knew how to use the spacer and inhaler.

Thanks all of you for your helpful support and info and for taking the time to post on this thread (by the way - what are SATs scienceteacher - not the tests he's just been doing at school, obviously ) We'll see how he is tomorrow, but I feel more reassured.

Nights are always worse, and he has been coughing a bit so I'm bracing myself for another sleepless one, although he's not wheezing anything like he was yesterday.

hi frieda, glad to hear your'e feeling a bit better about things. this hayfever malarky is a nightmare isn't it.
ds2 is 7 and has had it since the age of 3. the same thing happened in our case with the wheezing just like you describe. we were given just a preventer inhaler at the time and since then the doctors have never agreed whether it should be that or a reliever that he uses, they are really unhelpful!
ds2 has really bad hayfever, we have tried allsorts. i thought he was doing o.k until yesterday when his eyes started and tonight he is coughing, so far he's just on the reliever and i don't really know if i should just stick with that.
i hope your boy gets some relief soon. i'm hoping for rain!

Sleeping downstairs may help, also bowls of water on windowsills, plant sprayer squirted around the room. Dd1 and I both have countryside induced allergies, and doc suggests once or more of ventolin per week needs preventers. We take them for a few weeks only. Many people recommend cutting down on dairy, and taking very very local honey every day.