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

73 replies

Cathpot · 13/06/2008 19:39

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?

OP posts:
SlightlyMadSweet · 13/06/2008 21:59

Salbutamol is relatively easy to overdose on actually.....especially when you are talking about 6 puffs. In many hte side effects are short lived....but not always.

And trust me I know all about the prevelance and consequences of asthma, albeit from a different perspective to you.

QuintessentialShadows · 13/06/2008 22:04

My youngest son, now 3 had something similar.
As a newborn I noticed he struggled for breath wheen feeding, and he would maks sharp noisy intakes of air. At six month old he got bronchiolitis and I had to go to the docs twice a day for him to use a nebulizer for a week. At a year, he was hospitalized during his second bout of bronchiolitis, and left hospital with an asthma diagnosis, brown and blue inhaler, antibiotics and steroid tablets. I could not believe it. I threw away all his soft toys, I washed all the curtains, threw out all our rugs, bougth a new leather sofa, bought anti allergy bedding for all of us, in my fight against dustmites and allergens that could possibly make it worse.

Then I started questioning his diagnosis. I had to write down every wheeze, and every cough on a chart. And I noticed he did neither cough nor wheeze very much. But every time he laid down to sleep his breathing problems started, it sounded horrific, he would stop breathing, and then a long noisy intake of air, and sometimes I had to nudge him to get him going again. In the end he would find a comfortable position on his tummy, with tummy and chest on the pillow and his head "hanging down" on the other side, I could see there were no pressure on his airways and his throat and he could sleep.

I requested a second opinion. The paed found that his noises did not come from his chest, but from his upper airways, and he was diagnosed with laryngomalacia, mainly. His airways were soft and would flatten when he laid down, so he could not breathe. He also had a chronic inflammation of his airways due to all his problems but this would ease. He has been getting gradually better since then. I was adviced to keep giving the inhalers during coughs and cold.

If you do think you need a second opinon, get it, but meanwhile let your dc take the medicine.

Cathpot · 13/06/2008 22:23

thank you all very much for your advice, lots to think about and I feel much better about using the meds. A secondary question is will this have gone in her notes as a diagnosis? I am presuming not as we havent seen a specialist? My Dh is a military pilot and is throwing small fit about it as it would bar her from this career if it was on her notes even if she wasnt troubled by it as an adult. He mentioned a couple of other professions as well but I'm afraid I wasnt paying attention.... He basically doesnt want a speculative and possibly inaccurate diagnosis on her notes. Thoughts? (shes says ..carefully)

OP posts:
QuintessentialShadows · 13/06/2008 22:29

oh dear....
My dh threw a small fit when our son was diagnosed, but not because of his career limitations..... I hope he will be a little more understanding than you suspect. And yes, it will have gone in her notes. Everything does.

minorityrules · 13/06/2008 22:35

"Asthma is a wheeze/whistly noise in hte upper airways"

Actually, there isn't always any noise at all. My lot have never made any noise. |One coughs and 2 have shallow breathing, one with added skin going in in throat and bottom of ribs, they look like they have just run one hundred metres, so don't just rely on looking/listening for a wheeze

Ventolin won't hurt, try it for a few days as suggested. Not wanting to scare you but they can go from chesty cough to unable to breath and needed A & E quite quickly and just because it hasn't happened yet doesn't make it 'not asthma' And of course, some never have to go A & E and are managed with inhalers forever

misdee · 13/06/2008 22:37

yes it will be on her notes.

tell dh to stop being so silly. if it helps her get the treatement she needs then so be it.

dd1 also doesnt wheeze. she is more of a copugh-y asthmatic, the wheeze for her is often right at the end of an attack.

SlightlyMadSweet · 13/06/2008 22:53

but there is usually a stehtoscope audicle wheeze to GP.

My pont was that asthma isn't "a rattle"

misdee · 13/06/2008 22:55

my gp always says 'oh she is crackling a bit'

but i know what u mean SMS.

Quattrocento · 13/06/2008 22:56

Can I just ask if there is a family history of asthma or eczema?

minorityrules · 13/06/2008 23:12

Actually, my worst one has 'rattled' and the first year of his life he was wrongly diagnosed as having chest after chest infection (anti-b's after anti-b's). He would get a cold and rattly. Now when he starts rattling we up the inhalers and usually manage to head off nebs and steroids, never has anti-b anymore

There is a whole range of symptoms out there

SlightlyMadSweet · 13/06/2008 23:33

I am being mis-understood a bit here.

I am sorry I am not articulate enough.

A rattle is not a primary syptom of asthma, although it can be a secondary syptom on top of a wheeze - which may be less audible than a rattle to a paitent/parent.

How do you know he was "wrongly diagnosed"? It is not uncommon for (under treated)asthmatics to have more frequent chest infections. Now you are on top of hte nebs & steroids you are preventing helping him clear the secretions causing the rattle before an infection becomes established.

kee27 · 13/06/2008 23:42

hi ya hun my lill boy who is 7 now he was rilly ba wit bronkits when he was 3 months old h also had t be nebulised 4 times b4 he was a year old but i was told that they do not like to diagnose asthma till they r a year old he has athma now and has a peekflow to but when i had my daughter the told me she was the same lol but se was diffrent i knew it was just a clod that was doing her but no they gave her a pump and told me to give it to her which i didnt do as i knew she didnt rilly need it now she is fine but my lill 9 month od is going teh sam eway as my lill boy he has to be nebulised to so no he will nedd his pump but u know what hun they blame every thing on athma now days so just go with ur instinks i did and it helped

herbietea · 13/06/2008 23:43

This reply has been deleted

Message withdrawn

kee27 · 13/06/2008 23:46

aso 10 puffs should only be given in bad cases im to give my son 10 puffs in one when he has a bad a ttack its like being nebulised in hospital thay say but my lill man ends up there nay way having steroid injctions to open his airways the last one he had his oxigion leval droped from 100% to 30 % so they was so worrid he even told me mummy i saw a angel she was very prity wich freaked me out as he wwas only 6 and didnt rilly know about that lol but he was kept in for 3 days but is fine now thank god

tissy · 14/06/2008 14:30

kee27, I did say that 10 puffs was for a bad attack, and said that it was equivalent to a nebuliser.

I also suggested that the OP should use 2 puffs!

My point was that 10 puffs and hour can be given, if the condition warrants it. The main side effect is a racing heartbeat (which is faster in children than adults, anyway). Dd also had vivid dreams.

Sidge · 14/06/2008 15:25

A nebuliser actually contains either 2.5mg or 5 mg, which is either 25 or 50 puffs of a salbutamol inhaler so you can give 10 puffs in an emergency situation quite safely.

However a regular dose is 1-2 puffs every 4 hours or so. If you have a spacer and use it properly you actually get most of the dose.

Don't worry about it being on her medical records now, many children have asthma-like conditions but it doesn't necessarily mean they will have asthma, or always have asthma. Many children grow out of it. It can't be diagnosed properly until at least 5 or 6, and can be done by a GP or asthma nurse following either spirometry (impossible to do in a young child!) or by doing a peak flow diary for at least 2 weeks. The child doesn't have to see a paediatric respiratory physician, they tend to see children with brittle or complicated, hard to manage asthma.

I would give her the salbutamol as often as she needs it; it won't do her any harm and actually leaves the body fairly quickly so is unlikely to cause her any problems.

kee27 · 14/06/2008 19:26

tissy how funny is that lol bout the dreams lol its dose mk u think r they rilly seeing thease things coz my dd was so adment he saw one lol

SlightlyMadSweet · 15/06/2008 07:47

Please don't compare nebs & inhalers in that way.

100ug in an inhaler is v v v different to 100ug in a neb. They are not equivalent in any way. They are a different mode of delivery altogether. It is like comparing an injected dose with a oral dose.

Nemoandthefishes · 15/06/2008 08:00

to OP would give it to her for this week to see whether it is wheezy asthma or she may jsut be a naturally wheezy child although surprised at such a quick diagnosis as DD1 suffered attacks from 3 months old both hospitalised around 8 times and we are frequent visitors to a+e for nebuliser and steroids yet she was only officially diagnosed about 3months ago[2yrs after she started having attacks]

Also agree with misdee about care plan for treating asthma is 2 puffs but 5 breaths through spacer for any infant/child. Also the 5 puffs is only in the event of being very wheezy then you give 5 puffs and wait to see if symptoms relief. That is how we have been directed since DD1s first attack but a+e,gps, asthma nurse and walk in centres alike.

ScienceTeacher · 15/06/2008 08:03

I would say from the OP's description that 1-2 puffs would be more appropriate.

6/8/10 puffs is only really for a full-blown attack.

The number of breaths depends on the type of spacer. The bulky NHS conical thingies require 10 breaths, but more compact Aerochambers only need 6.

As for diagnosis, you can't make a diagnosis on a small child, but there are lots of tell-tale signs. It doesn't have to be called asthma for it to be serious. The next time your DD has a cold, her wheezing may be worse.

Don't be in denial - I was and ended up carrying an unconcious toddler into A&E.

Nemoandthefishes · 15/06/2008 08:04

also agree gp may have heard a wheeze on the chest which my lovely asthma nurse let me hear once on dd1 even though she wasnt visably wheezy when I listened to her chest you could hear it very clearly.

princessmel · 15/06/2008 08:33

Just wanted to say in respone to the people saying that asthma isn't diagnosed till they are 3, that my ds was diagnosed with asthma at 18 months and put on a brown inhaler twice a day.
He wasn't given the blue one till he was 2.

But it helped him so much. He could finally sleep without coughing all night.

You say she is coping with it pretty well but we dont know how she feels inside. This may really relieve her and make her much more comfy. I'd use it and see how she gets on.

misdee · 15/06/2008 08:42

oh dd1 has never been 'officially' diagnosed as asthmatic. she had hyer first inhaler at under a year old, and was started on the brown one a few months later. she had her first hospitalisation at about 2 (after witch of receptionist wouldnt allow her to have an emergency appointment and told me to take her home), and has been on dark brown inhalers and blue ones ever since. plus prednisole tablets after each serious attack (added bonus of cl;earing up her eczema at the same time)

princessmel · 15/06/2008 08:43

Ds has moved onto the purple one now and its great.

misdee · 15/06/2008 08:47

is it?

i think dd1 needs a review of her meds.