ASTHMA QUESTION. YOURS VIEWS VERY MUCH APPRECIATED.....

[drosophila]

DS is asthmatic but only ever seems to get an attach with a viral infection. Usually it starts with an incessant cough and I take him to GP. Depending on GP they will listen to his chest and say either :

1.he sounds clear or

1. he has a wheeze.

If he has a wheeze they will say either

1. Keep doing what you are doing (steroids and salbutamol (sp?)

2.He needs a nebuliser (sp?)

1. He needs oral steroids.

I rarely see any difference in his sympoms to explain the diddering resposes and find it impossible to know when to go to GP. At present he has a pretty incessant cough but his breathing seems ok (probably because I have been giving huge doses of salbutamol).

When is a cough asthma and when is it just a cough cos you have a viral infection? I ask the asthma nurse this and the GPs and I never get a straight answer. Anyone have any thoughts on this?

Anyone bought a nebuliser? I am tempted.

Hi drosophila.

I think when you have a cough following a cold you are more likely to be coughing up phlegm, but if you have asthma, you can have a wheezy chest and a dry cough following a cold. Any breathing difficulties/asthma are often exacerbated if you have a cold - and an inhaler won't get rid of the infection, just makes breathing easier. A cough due to infection will either just clear up or require anti-biotics if quite bad.

Reading that back, it doesn't make an awful lot of sense , it's hard to describe the difference, but there is one, at least in ime.

Why is your ds on steroids, do you mean he has a preventor inhaler and a salbutamol one?

I was given a rule sheet for how to tell when I need to go to the GP about my asthma. I have a peak flow meter, and if I blow into it three times and never get a result over (some number), despite having had salbutamol, then I need to go to A+E.

(That being said, I never use the peak flow meter. But my asthma is pretty mild, and only really acts up when I have a cold, or when I exercise in cold weather.)

My DS was just diagnosed with asthmat this summer. My DH used to only get asthma after infections like your DS, but my DS just seems to have it. BTW DS is 2.4

As I understand it (not being medical) a cough is one of the symptoms of asthma. Especially a cough at night. I think it is hard to tell just from a cough if it is a virus or asthma. If my DS asthma is kicking up because he has a cold his breathing gets a bit faster, and he usually this little indentation on his chest between the top of his ribs (our asthma nurse pointed this out as somthing to look for). If he has this and I take him in, then his chest is wheezy. So seems a good inidicator for my DS.

I think that asthma is not well understood, therefore the differing answers.

I find this website good. Asthma UK

We've only ever had oral steriods when DS it was suspected that he might have asthma (there were a couple other possibilities). But as he had gone blue the day before, they treated it as asthma. We only had the oral steriods (disolve stuff in drink) for 3 days. But have a steriod inhaler, and a blue one for attacks.

We don't have a nebuliser.

My ds had asthma form the age of 5months following brochiolitis (RSV). He always got v. wheezy following a cold. After a particularly scary experience involving a dash to GP to use their nebulizer, I bought one.
However, I never needed to use it because I got into a routine of increasing his Preventer inhaler to 3X2puffs per day as soon as he got a cold. I added in the reliever as and when necessary.
The preventer is so important. I still increase the frequency if he gets a cold and he hardly ever needs the reliever. He is now 15 and otherwise very healthy and active.

That's what I need some clear pointers. Anyone with a cold can get an incessant cough and it doesn't have to be asthma and this for me is the problem with diagnosis. The GP can use his stethoscope and know instantly the difference.

Steroid inhaler is the norm but he has had oral steroids a few times.

Do you have a peak flow meter? If you monitor the peak flow, you will be able to manage the asthma much better, and will know which inhalers etc you should be using.

I'm really amazed at the number of young children using a steroid/preventer inhaler tbh. My db has had asthma all his life (now 36) and has only just been prescribed a preventer - many years too late ime, and uses it in the same way as 3littlefrogs' ds.

One thing my db does when he is wheezy is to cut out dairy products and increase his fruit/veg intake - he swears by it! he says it particularly helps with eczema (althugh I know this isn't necessarily possible with very young children)

My ds (4yrs) uses both preventer and salbutamol inhalers but has recently been prescribed a drug called spirolaine (or similar??).This reduces the allergic reaction causing the asthma when he has a cold.
Previously he has had to have oral steroids everytime he caught a cold,since taking this new drug he's had a cold and we managed with just increasing his inhalers.

You can also tell if it's his asthma as he uses his shoulders to breathe(accessory muscles).I assume it's asthma after a day of incessant dry coughing and increase his ventolin.

We were given a card with the protocol of what action to take when,ie if the blue inhaler is being used 5 puffs /4 hrly and no improvement is seen,we need to seek advice.

have you an asthma nurse?

Yes have an asthma nurse but I don't find her particularly helpful. After the last post I thought I heard wheezing and gave him sal but I have to give at least 6 puffs. I phoned GP and was told that they could not see him and I should await the out of hours doc or go to A&E. It's not bad enough for A&E but I would like a doc to listen to his chest and maybe use nebuliser ( I have probably given him the same dose as a nebuliser now). I am currently awaiting the out of hours doc to phone.

I find it very hard to differentiate between a bad cough caused by infection and asthma and keep wondering if I can hear a wheeze cos when you have a cold your breathing sounds congested anyway. It's only when a doc listens to his chest that I know for certain. I will look for the shoulders thing.

I did a Google and couldn't find Spirolaine ( I tried a few different spellings) I would be very interested in more details if you get a chance.

sorry to take so long to get back to you,only just seen this,
It's SINGULAIR he's on,sorry for the confusion.
He's on 4mg /day
It's also called Montelukast

actually the blurb on the leaflet thing says;

Symptoms of asthma :blah blah...However not all people with asthma wheeze.For some coughing may be the only symptom of asthma.

My asthma nurse suggested it after ds needing nebulaizers and oral steroids everytime he had a cold.After one cold the results look promising but we'll wait and see.
hth

i too am really confused with the whole asthma thing. ds2 was given an inhaler at the age of three when he became wheezy with his hayfever (which is really bad)

since then, i have never seen him out of breath even when running etc but, when he gets a cold he ends up with loads and loads of phlegm and sounds wheezy.
he always coughs with that a little bit but sounds as though he should be coughing a lot more iyswim

each doctor has treated it differently, we have had antibiotics from one , steroid tablets from another and been told to just use reliever by another.

he gets like this alot and i really don't know whether it's asthma or not.

does asthmatic kids just get dry coughs? does this sound like asthma?

hope you can work it out for your ds drosophila

Cheeryface, when my DD's asthma returns I know as she has a dry cough espec at night. Also she complains that her chest huts and feels tight.

DD2 has dairy allergy and has a phlegmy cough.

Maybe take yours off all cow/goats milk for 14 days and see if cough clears up?

Well, ds was admitted to hospital last night with suspected pneumonia and breathing difficulties. They saw a shadow on his lung's xray but in the end decided it was calcified lymph nodes which are deposits from old infections. They treated him for an acute asthma attach to with oral steroids etc.

I spoke to the docs about SINGULAIR as they figured out what I meant. We have now been referred to special Asthma clinic which is run by the same consultant that ds is under for his allergies which to me is fantastic as the link is so obvious.
What do you think of this sequence of events:

I rang our Go at about 17.30 and explained that I though DS needed a nebuliser the receptionist spoke to the Doc and came back to me and said that the Doc couldn't see him (never asked who he was). They didn't offer an alternative. I asked for advice as to what to do. Try the 'walk in centre' they said. I phoned the 'walk in centre' and they don't have a nebulsier. I called the GP again explained this and asked for further advice. Wait until 18.30 and phone the out of hours doc they said. I did and it was two hours before we spoke to anyone who recommended we went to the 'Walk In Centre'. DP did this and after wasting 45 mins was told to go to A&E. DS did not get a nebuliser until 03.00 (by which time he was quite bad) with all the faffing about which involved a triage nurse demanding why DS had not had an MMR despite being told that DS has severe allergies to egg ( and a host of other things)and has had measles the nurse became aggressive and asked if ds had a social worker The nurse also maintained that he could get measles again.

Is there any point in complaining and if so to who?

should I have said to whom?

bloody hell,your ds had to wait until 3am for his nebulizer? That is disgraceful poor wee thing.Sorry to hear he's so unwell.

As for the nurse geting on her high horse about the mmr...that really riles me My ds has egg allergies and nuts and we were virtually bullied into giving him the mmr when it was discovered at age 2 that we hadn't done it yet.The allergy consultant practically marched us up to the ward !We've decided not to give him the booster.I don't think there is any relevance anyway,your ds wasn't presenting with symptoms of measles or mumps was he?

I think it was disgraceful that the gp sent you packing,I would write a letter of complaint to the Practice manager.

.Is he on regular nebs now?Did he have a temperature?I'm interested as dd has been chesty for ages and I'm concerned,but no temp.

What did the drs say about the singulair?

I get asthmatic symptoms when I get a cold or cough and was told that as soon as he looks likes he's getting a cold or cough start him on his brown (steroid) inhalers and keep them going for at least 2 weeks .. certainly till after its clear

Well the advice was:

10 puffs of Salbutamol every 4 hrs for 2 day and then 8 puffs for two days.....

Alongside this oral steroids for 3 days and then ensure I give him his inhaled steroid every day thereafter regardless of condition.

The only thing I was told about Singulair is that it can help if asthma is allergy related which could be relevant to DS but that it must be used with inhaled steroids. The asthma clinic nurse, who was very good, said that it would be considered for ds further down the line which is a positive thing I think. It's the first time I feel that I understand what to do.

Do you think it is reasonable to have expected the GP to squeeze DS in at 17.30.

my gp surgery usually will squeeze ds in because of his young age and the fact it's a probable asthma attack.As soon as I say his age and breathing problems I get in straight away.But I have never tried them when they're closed.I must admit I would expect them to take him at closing time,would be pissed off otherwise

btw ds is on steroid inhaler4 puffs a day and the singulair.

The surgery actually closed at 19.00 so 17.30 was nit outrageous I think.

Hi dros - sorry to hear about your ds but glad to hear you've found a good asthma nurse. They can be a real help!

wrt your original question - in terms of knowing the difference, I don't think (unless it is glaringly obvious the child is wheezing) that as parents (i.e. not doctors) you can tell the difference between coughing and wheezing.

I agree with Twiglett though - as soon as dd gets a cough (or e.g. at a time of year when you know their asthma is likely to start getting worse - so for us hayfever season and winter), we up the inhaled steroids STRAIGHT away. It does make a big difference. We upped dd to her maximum dose in advance of hayfever season this year and it did make a difference to her coughing.

Also, I don't know how old your ds is, but we found for the first 5 years of her life, dd's asthma was much more of a persistent cough than a wheeze. I think one of the big differences between asthmatic children and those who aren't is that when they get colds, the cough goes on and on. Even if that cough isn't always a wheezy one, we have found that the inhaled steroids tend to make a difference to the length of time that cough hangs around.

Sorry I can't be of more help - hopefully, you've now found the right clinic for your ds and I hope he gets better soon.

Sorry to hear about your DS's experience, Dros, and hope he is feeling better. We do have a home nebuliser for DS2, now 5, and, as I have posted before, it kept us out of hospital and off oral steroids numerous times - he was able to take a bigger, more effective dose of both bronchodilator and inhaled steroid via the nebuliser, which nipped his wheezing cycle in the bud.

Both DSs have asthma - DS1 much less severely, but his wheeze is much more audible, so it sounds worse than DS2. DS2 doesn't wheeze very audibly, but has a frequent dry cough when he is tight, and when he is getting bad the cough sounds choking at times.

DS2 is on inhaled Flixotide, inhaled Serevent and Singulair all year round, though this year we dropped the Flixotide for the summer.

Drops,I can't believe they turned your ds away when they were still open ,that is definately worth a letter I think.Bloody outrageous.

Drops,I can't believe they turned your ds away when they were still open ,that is definately worth a letter I think.Bloody outrageous.

Drosphila I am appalled at your story.
I am even more appalled that the bolshy nurse asked if he had a social worker?!! I would want the name of that Triage Nurse and take the whole situation further.

I would have expected my Gp to have squeezed a small child in if breathing problems.
Ours is a very busy town surgery but if I ever say I am worried about a child they ask me to come and wait at end of surgery and they ask whichever GP finishes first to see us.

DD! has asthma and a lovely asthma nurse at the practice.
Hope things are better today for him.