5 mins with the doctor and now my daughter has asthma? advice please

[Cathpot]

A long one bear with me:
I took my DD2 - 16 months into see our very nice doctor today as I was worried she had an ear infection - which it turns out she did. While I was there I mentioned we'd had a rough week or so as she had a really horrible sticky cold, and was coughing up handfuls of flem and had been frequently coughing and then throwing up her food or milk. I also mentioned the fact she has always been a 'chesty' child, since day one after a very fast birth (which a HV suggested might be a factor), and in fact the first 3 weeks she was more or less strapped to me at all times as when she lay flat she struggled to breathe. Since then she seems to take a long time to get over colds and alwasys sounds very rattly when she has one. Having said all that the only time I have been really alarmed by her chest noises was at 12 days old, and an on call doc sent us to the children's ward, where they then explained that yes she had a cold but the noise was actually in her upper passages and reverberating in her chest, ie it sounded much worse than it was. Anyway, today the doctor listened to her chest , said she was a bit chesty and she probably had mild asthma and gave me an inhaler- Ventolin Evohaler. SHe told me to use it in the day if she would let me and if not to pass it over her nose in her sleep. I also now have an appointment with the asthma nurse next week to 'see how we have got on with it'. I have come home a bit taken aback really and very reluctuant to start her on drugs when she is coping with it all pretty well and hasnt been sick now for 2 days. Is it OK to start using drugs like this on what seems to be the off chance she might have asthma? Any one with any advice or experience in this area?

A ventolin inhaler will not do any damage in the short term. Is she wheezy ? Passing it over the nose whilst she sleeps is a bunch of crap by the way. Just gives ventolin to the room. Did they give you a spacer thingy. If not ther is no point using the ventolin.

As for the asthma diagnosis, she needs to see a chest paediatricain before an asthma diag can be made at that age. Go and see the asthma nurse, and get her to make a referral if she agrees with the doc.

My dd was very like your dd, and it turned out had pneumonia. She had had a constant cold since 5wks. She is now 11mths.

I'm no expert, but I didn't think children we're officially diagnosed with asthma until they were older, and able to take peak flow tests etc.

My DS ( 18 mths) has had asthma symptoms, managed with the inhalor you mention, plus those little pink steroid tablets that I've forgotten the name of.

Saying that, whether it's officially diagnosed as asthma or not, the treatment at this age is the same, I believe.

Has the doctor given you a spacer to use with the inhalor? - it's a big plastic cylinder thingy with a piece that fits over her mouth ( rubbish description, sorry) If not, I can't imagine how on earth you'll get her to actually inhale anything from the puffer, but maybe my DS is just awkward.

If you've not keen to use it and she seems fine, then don't, but I'd keep the appointment with the asthma nurse and explain your concerns to them.

Hope some of that incoherent waffle is of use!!

Agree with JoJay, I was told they had to be at least 3 before they would diagnose asthma - it took til dd1 was four and admitted to hospital for two nights before they would admit she had asthma ! And thats with a strong family history, and eczema etc ! They just kept giving her cough medicine and sending us away. So I would question what you have told, but definitly see the nurse though.

Cough medicine also crap. Has nothing in it, just used to make parents feel better. I sound really pesimistic but just been an A&E nurse for a very long time

Yes, I have an inhaler thingy- I suppose I just am reluctant to start giving her drugs when we have just seen her as having 'a weak chest' ( very medical I know), ie she gets hit hard by colds. I have a good friend who also has a child with suspected asthma and uses an inhaler, but he has twice been admitted to hosiptal as he needed oxygen and ended up on drips etc for a couple of days - I suppose I had been using him as a bench mark for what suspected asthma looks like. Are you saying that her much milder symptoms could also indicate asthma and also would you start the inhaler if she seems to be on the mend?

give her the inhaler, if it sppears to work, and relieves her symptoms, then its a good thing. if its not asthma, then it may help her get over a cough/cold as it helps the airways which are very little in young children.

its hard to diagnose asthma in the under 5's. dd1 has had asthma since she was under a year old, has been hospitalised at age 2, struggling to breathe and o na nebulsiser. has had several attacks at school as well.

her mild symptoms could indicate asthma yes. she could be what some call a 'happy wheezer', has symptoms but doesnt affect them that much. or she could sudddenly have a serious attack.

Similar story with our DD1. Although not "diagnosed" by our GP but on holiday so ended up at the casualty unit as she deteriorated rapidly into a very nasty chest infection. Given an inhaler, told she would prob need ventolin etc for years and generally frightened us. Infection cleared up, asthma vanished never to return. Ventolin is in back of the cupboard in case she develops another very bad cold. Although, to be honest, if/when she does, chances are the inhaler will be out of date!

I recently took my son to the doctor as he is always wheezy and had bronchiolitis as a child which I was told is a risk factor for Asthma. He is 3 1/2 and I was told he was too young to be diagnosed and just to wait and see how he got on. I was quite happy with this as although he is wheezy it doesnt seem to affect him but I'm not sure when they do diagnose it. Presumably if they are younger and have severe symptoms they can diagnose it earlier or at least assume they have it?

there is nothing to lose with the inhaler. You will only need to use it once when dd is really chesty and you will see if it works or not. The spacer thing, you have to put it firmly over her nose and mouth and squirt one puff into the spacer whilst it is on her face. She must then take 6 breaths. You must repeat this 6 times. A bore I know, but that is the only way that the right amount of ventolin to be effective can be given.

Your dd will cry I am sure, but they do tend to take really big deep breaths when they are crying so good for opening their lungs.

repeat it 6 times?

dont you mean 2 times?

If you do decide to go ahead and use the inhaler, remember a dose only has an effect for a couple of hours. It's designed for short term relief only. ( as I understand it)It's not designed to be used for weeks on end, more as a short term treatment when symptoms seem bad.

If it helps her breathing then it's worth using, and the effect is generally very quick.

Nope, for a child it has to be six puffs and six breaths for each puff. Sounds an extreme amount but that is what is done in A&E depts.

Oh and ventolin is a 'reliver' not a 'preventer' so has no use used every day. Just when they are wheezy etc.

but surely in a+e deptartm,ents its done as an emergency.

have always done one puff 10 breathes, repeat.

if no effect within minutes then repeat.

repeat 5times.

if no effect then call hospital/docs (our Gp has a neb and is closer than the hospital) for further treatment.

Thats the way that we do it. You find that asthma/inhaler care is really inconsistent. Most gp's don't even tell their patients how to use the spacer device.

well have been doing it for 8years this way, and has been checked atr asthma clinic, allergy clinic and GP many times and we are doing it correct.

and for anyone who is unsure what to do in an attack

and remember not all attacks are accompanied by a noticable wheeze

Well if that is what you clinic suggests I would keep doing it. As I said Asthma care is very inconsistent and a lot of people, including dh, don't know what the brown and blue inhalers are for.

The Asthma UK website recommends one puff, then 5 breaths when using a spacer for toddlers under two.

Here

Now I feel bad 'cos that's not what we've been doing with DS

Agree that Asthma care is very inconsistent!

I agree with everything that has been said.

Ventolin for week won't hurt.

Your asthma nurse will actually be a lot better trained than your GP.

She will have a lot of specialist experience with asthma patients and you should see if she can address your concerns.

The thing from your post(s) that conern me is that a "rattly" chest is not really a symptom of asthma. Asthma is a wheeze/whistly noise in hte upper airways - it is because the airways have narrowed and the air is whistling through. The ventolin opens them up again. Your GP will have heard this wheeze to have prescribed ventolin. BUT some colds can be associated with this closing of hte airways and you are right it doesn't necessarily mean that asthma - although I suspect he is going on the history for guidance here.

Having said that the "rattle" is caused by mucous/phlegm on the chest which asthmatics can be prone too as they don't clear it quite as well. It is more of a consequence of the asthma than a syptom IYSWIM. Just because she has a "rattle" doesn't mean she has asthma IYSWIM.

WRT the discussions on 6 puffs for a child....I would not advocate this for a child (especially a toddler) in an environment other than A&E. The dosage instructions from GSK - the maufacturers is 1-2puffs for children with a suggested maximum of 8 puffs/day (unless advised otherwise).....so 6 puffs is way over hte mark. The GP has doesed correctly.

A&E is medically supervised and the extremeness of the situation obviously necessitates a more aggressive treatment than in the home.

I would not advocate A&E doses of anything in the home for that reason. A&E patients are acutely ill and as such may requirer larger doses/stringer drugs than are appropriate for use at home.

yes sms i agree. but we have been advised to do the a+e doses at home whilst trying to get to a+e/GP as well.

i really dont like the way asthma is played down these days. people forget it is a serious conditon and asthma does kill.

that isnt a rant at anyone on here, but general society on a whole. i think it is now so comman (1 in 10 children IIRC) thjat people just forget.

dd1 is at a giant sleepover tomorrow, and fortunatly is competant enough to cope with her inhalers by herself now at age 8, so i know they will be done.

We were told 6 puffs was OK too, Misdee.

We were also told that it was virtually impossible to overdose as the nature of the puffer / spacer is very inefficient, esp when combined with a squirming toddler.

yes but it does make the heart race, which dd1 doesnt like.

I absoluetly agree Misdee - but you are using A&E doses en route to A&E, with proper medical advice, your DD(s) are older, and you have a lot of experience (unfortunately) with asthma. You are using A&E doses in an acute situation. This is a lot different to what Cathpot describes.

I was just qualifying what Lullaby was saying for those that may happen upon this thread from Google/the archives and think that they need to give 6 puffs routinely IYSWIM.

despite what the manufacturers say, ventolin can be given in MUCH larger doses, and is pretty safe.

When dd had asthma at about the same age we were told by Consultant paediatrician we could give 10 puffs per hour! This was obviously for a bad attack, and is as effective as a nebuliser. Childen who end up in A+E with wheezes have usually already had their usual 2 puffs of ventolin, so more is warranted.

having said that, if your dd isn't really struggling for breath, I would give the 2 puffs only, then see if there is any improvement in the cough.