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?

Yes. The brown one seemed to have stopped working for ds. He was coughing on the way to school after we'd only been walking to the end of our road. And after he'd been on his scooter and on the trampolene.
He was waking up and coughing loads in the night too and needed 10 blue puffs twice. Despite having the humidifier going every night.
We were on the phone to NHS direct quite a few times. Then we went to see the nurse and she gave us this purple one (seretide), 1 puff twice a day puls a course of steriods, and that set him back on track.

He hasn't had his blue one atall since Feb. Actually he had a puff on sat when he broke his arm.

The nurse told me that they give the brown one out first and that is usually enough but if it's not working they move onto other types.

DD1[2.6yrs] is on clenil modulite[brown] 2 puffs twice a day and salbutamol 2 puffs twice a day plus whenever else needed which at the min is too often!! Also been put on singulair about 3weeks ago which has made little difference as yet. Also goes on prednisilone about once a month or so which means she still isnt under control but like misdee does wonders for her eczema at the same time..as I type she is playing with her brother and due to running around is coughing and wheezing but what am I supposed to do?? Pinning her down isnt an option well would give me some peace..lol

dd1 didnt do her inhalers this morning at sleepover, so i did pin her down lol.

dd's dont get on with the clenil modulaite inhalers, they make them cough, its the same medication thats in the allen and hanbury ones, but a different propellant, which arrgrevates them.

oh now thats interesting as Hs constant cough has been since she was switched over..

does she cough as she inhales it?

i have a couple of clenil ones here which came in the last perscription, and some a+h ones and another generic type make (we get two of each inhaler for eahc dd, dd2 is on a different dosage). only the clenil are aggrevating.

Slightlymadsweet my comparison of nebs and inhalers was in response to the poster who said that 10 puffs of an inhaler was equivalent to a nebuliser. It isn't at all, and as you rightly said people shouldn't compare inhalers to nebs. The dosage and uptake are completely different.

I was just trying to clarify the dosing comparison.

I appreciate that - but you implied that 1 neb is 25 puffs of an inhaler.

It is not that either. You cannot compare at all. Full stop.

You should follow GPs advice for all meds.
The GPs advice in this case is the same as the manufacturers instructions.

In an emergency situation - you may be advised by a medically qualified person that in those circumstances 6 (or even 10) puffs is appropriate in those circumstances.

What I was trying to say was that 1 puff is 100 micrograms, and a nebule is either 2.5 mg or 5 mg, so if you wanted to compare then a nebule is more like 25 puffs or 50 puffs than 10.

So giving 10 puffs of the inhaler in an attack situation is quite safe as it is still less than half the dose of a nebuliser, and 10 puffs via a spacer is the recommended dose in an emergency management plan whilst on the way to seeking medical attention.

"What I was trying to say was that 1 puff is 100 micrograms, and a nebule is either 2.5 mg or 5 mg, so if you wanted to compare then a nebule is more like 25 puffs or 50 puffs than 10."

But thats the point it is not.

With a neb the vast majority of the drug gets stuck in the nose and doesn't get anywhere near the lungs.

Many estimates put 90%+ stuck in teh nose....which means that a 2.5mg neb is actually closer to just 2-3 puffs in terms of effect & exposure. Those are teh figures which are quoted by the scientific literature.

For eg. here

Sorry I meant to include the quote

"One nebulizer treatment
(2.5 mg of albuterol) is equivalent to four puEs (0.36
mg of albuterol) given by the inhaler system"

And I meant to say 3-4puffs....

DP distracted me....

But isn't uptake higher in children because they mouth breath nebs rather than adults who tend to nose breath? (don't have a reference as am trying to dredge up the info from my course a long time ago!)

The point I'm trying to make (albeit not very well obviously ) is that parents whose children are having an acute asthmatic episode are perfectly able to safely give them 10 puffs of their inhaler as it still a smaller dose than a nebuliser (technique notwithstanding) which is what the emergency services will give the child anyway.

I disagree with your last part of your last statement actually. Personally. I don'[t think that 10 puffs is less than a ned, even in a child. Having said that I honestly don't know exactly how nebs and inhalers compare specicifcally in children.

The point I am trying to make thoughout this thread (sorry to OP) is

a) it is not acceptable to tell someone that there GP is wrongly dosing because A&E do something different
b) you should alawys follow medical advise on dosing
c) You cannot in any way compare the numberical dose ofr a neb v inhaler. You cannot imply safe doses from an inhaler as a result of the numbers on the neb.

10 puffs may well be safe in an emergency - but that will have been etermined empirically - and not "because thats whats in a neb".

I agree with you on points a and b, and regarding point c I disagree as the current recommendations are 10 puffs should be given via a spacer in an emergency, a further 10 puffs can be given if no relief and an ambulance should be called. This must have been empirically proven as it is part of the BTS asthma management guidelines.

I don't have the references to hand but you can compare dosages - salbutamol by inhalation can be compared whether via inhaler or nebuliser as I believe the research has focused on the effectiveness of the 2 delivery systems using comparable doses.

Don't get me wrong - I am not saying that 10 puffs is wrong (in the right situation).

I am saying it it wrong to say (or imply) 2.5mg given by an inhaler (25 puffs) is the same as 1 neb of 2.5mg. IT is not....

I was concerned that you are (at least implying/or could be interpretted as saying) that giving 25-50 puffs of an inhaler is the same as having a nebuliser. IT IS NOT.

There will be a comparable dose. Of course there will. But it is not 2.5mg inhaler = 2.5mg neb'd. Therefore you cannot say that 20 puffs = 1 neb.

No no I didn't mean that at all!

I meant that 10 puffs is OK to give in the right circumstances as it is a safe dose. I should have put the word "equivalent" in my first post, I was never meaning to imply that 25 puffs = a nebuliser.

Quintessential (if you're still reading this thread ) my dd2 has laryngomalacia, and I can relate to a lot of your post.

She nearly died of bronchiolitis at 4 weeks, and even at 19 months is still a scary sounding breather at night during colds/coughs.

She now has blue and brown inhalers 'in case they help' when she has a cold, and because she developed a night cough (indicative of asthma, possibly) but I was told to give one puff of each, with spacer/mask, or two at the most. I've no idea if they help, but basically don't dare not use them - yet!

My 4.5 yr old has mild asthma triggered by viruses, and exercise, usually both together - she's got it mildly now, first time since September, and although she's never had an asthma crisis as such (or complained of not being able to breathe) she does end up with chest infections if we don't use both inhalers as soon as she starts a cold/cough.

Both dds have mild eczema, too.

I find this such a frustrating, vague area...sounds as though many of us do, with young children.

Phew...I think we are sorted Sidge......it is just the way it read on my monitor.

I was only challenging it as I didn't want someone to interpret it incorrectly and think that there is no point in going to A&E because "theyt are only going to give him/her 25 puffs of salbutamol, I can do tha at home".

I hope you can see why I challenged it.

Absolutely SMS, I am always happy to be challenged it keeps me on my toes!

I find it difficult sometimes to get what I'm trying to say across in a post, writing it never seems to make as much sense as it would if I were saying it face to face! It's much easier in a consultation to explain things as the dynamics are so different, dialogue flows much better than writing on a computer.

(Sorry to the OP for the hijack, trying to clarify things can cause it to go off on a bit of a tangent!)

would just like to say that my 7 year old is a regula at the hospital having to be nebulised i would say at least twice every 2 months and i was told by the parmedics and the peditrisions that when he gets like that i am to give him 10 puffs of his beconesol / brown pump hope i spelt that right lol why i am waiting for the parmedics to arive or if i have the subtmol to hand use that to he has now been giving a nebuliser at home with all the meds to go with it so i think we must all be told diffrent things lol or it all depends on how bad ur child is at the time see my 9 month old had bronkits which the doc told me that he to will prob have asthma i did not bye it tho just because my older son has it his sister dont any way he wa very ill with it and one night was so wezzey he stoped breathing and went blue so was rushed to hospital after the parmedics worked there majick hand on him thanks god they also nebulised him to when he finly got his breat bk and his couler come bk i was told that hi air ways was so swolen that is why he stoped breathing but he was kept in for a few night and when i asked the peditrision if he will be like his older bro i was told no pro not just bad infection so i think they just label asthma as thay carnt be assed to say emm bronkits or chest infection lol

sorry didnt mean give 10 puffs of both only one of teh inhalers what ever one i have to hand at the time lol

SMS- I apologise if I have been the cause of some confusion.

I was told by a Consultant paediatric repiratory physician that 10 puffs of salbutamol is eqivalent to giving a nebuliser. In our hospital, nebulisers aren't used for children at all, any more.

I can do the sums, and questioned that, and was told that the reason for the difference in dose delivered was that with an inhaler and spacer, properly used (good seal on the mask, good deep breaths and a minute between puffs), a far higher proportion of the drug actually gets to the lungs. With a nebuliser, a LOT is wasted into the atmosphere from the sides of the mask.It is therefore difficult to know how much the child actually gets.

I am not trying to mislead people, I just challenged the idea that 2 puffs is the maximum dose of salbutamol.

No tissy.

What you said was fine.

Everything I got frustrated at has been resolved

i am the trustee for a local asthma charity.

it is a very grey area when it comes to diagnosing children.

personally i would try the drugs and see how she goes.