Asthma and swine flu

[Frasersmum123]

Im sorry for posting another swine flu topic, but I am a little concerned.

My DS is 8 and has moderate asthma, but its not very well controlled when he is poorly and last time he had a bad cold he ended up getting a bad chest infection too. I have made an appointment with his consultant but that is not until the end of next month. His chest is bad at the moment due to hayfever and so he is taking his preventer as usual plus taking his reliever 2 or three times a day.

There is swine flu in the area and I am a bit nervous about it.

Is there anything else I can do? Will a flu jab help?

Speak to your asthma nurse, or ask for a telephone consultation with the consultant.

A flu jab won't help.

Does he have a regular antihistamine for his hayfever? What does he take - can he increase his inhaled steroid? He can have 4 hourly salbutamol whilst he has a cold (that is the current advice).

Avoid people that are unwell and if he has a cough or sneeze remember to catch it, bin it, kill it and be scrupulous about hand hygiene.

If he displays flu-like symptoms ie very high fever, sweats, chills, vomiting and/or diarrhoea call your GP and ask if he should have Tamiflu - it's currently being prioritised for the more vulnerable.

This has been worrying me too, as last time dd's asthma flared up she needed 6 lots of nebuliser and 2 doses of steroids to get it under control, and it was pretty terrifying for a while. As she's only 3 it's all the more scary (esp as they still refuse to diagnose her officially.)

I've got her on a steroid preventer twice daily at the moment but not sure what else might help, other than what sidge has just suggested. Will watch this thread with interest though, good luck.

I've always been told to double up the dosage of my preventor at the very first signs of a cold by my asthma nurse, and this usually prevents a chest infection setting in.
Does your DS monitor his peak flow at home? It might be worth keeping track of that up to the appointment and then discussing with the consultant some kind of peak flow "threshold" at which he should increase the preventor - it would give you an element of control and confidence about self management.

Am watching this thread with interest - dd1 has a preventer to use at first sign of a cold (she has mild asthma, but often ends up with a chest infection when she gets a cold, without the preventer).

dh also has virus-triggered asthma - worse than dd's - and uses a preventer all the time atm. He has a prescription for oral steroids to take if peak flow drops below a certain level.

I think, reading your posts, an appointment with the nurse or GP for dd1 would be a good idea - I have no idea how to manage things if she starts flu, and we are in a relative hot spot (SW London). No asthma nurse at our surgery, afaik, either

Elibean I didn't think our surgery had an asthma nurse until I asked the receptionist instead of the GP (who had no real idea). turned out one of the practice nurses was trained in asthma management and sees all the asthmatics and kids awaiting diagnosis etc. She was much more knowledgable about treatment than the GP tbh...

Or your surgery should have access to one from another surgery.

Dd4 has just been prescribed tamiflu due to a teaching assistant in her school having confirmed swine flu. Her athsma is playing up at the moment and g.p wanted to err on the side of caution.
They won't prescribe it unless its confirmed cases but they are not confirmimg in all areas so it doesn't help much
I would just keep her away from anyone with heavy colds etc... (children with heavy colds or flu symtoms shouldn't be at school anyway)

Elibean I would certainly recommend asking your surgery if one of the practice nurses does asthma. Taking a preventer at the first sign of a cold won't necessarily help as inhaled steroids take about 2 weeks to have any real benefit. It may be better that your DD1 takes a regular preventer over the cooler months for example, and then increases her salbutamol use for a cold.

I agree that nurses often know more than GPs about asthma - I had an asthma qualification as a practice nurse and had regular updates about new therapies and respiratory issues, unlike the GPs. If your surgery doesn't have an asthma nurse your local hospital may have a community paediatric respiratory nurse - ours does a drop in clinic at local health centres that have no in-house asthma provision.

We have a lovely asthma nurse at our surgery - Barnes. Have just stocked up on steroids for the boys. They don't take them regularly but need them if they have an attack.

There won't be a specific vaccine against H1N1 (swine flu) until the end of August, and your DD should be prioritied for it - asthma, diabetes and front-line NHS staff to start with and then everyone else as more vaccine becomes available. A standard flu shot will protect against seasonal flu but if your DD has moderate asthma she may have had one already last winter so there wouldn't be any added benefit.

She should be given Tamiflu early if she meets the criteria for diagnosing swine flu ~(what sidge said!). You should manage her asthma in the standard way - double up the preventer at the first signs of a cold/flu, and it may be that she would need a course of oral steroids. An appointment with the asthma nurse wouldn't be a bad idea. The GP is likely to be snowed under, though!

Hopefully people won't be sending their kids to school with colds/flu but some infections are very mild and may not be obvious - so concentrating on standard hygiene stuff - hand washing etc. - will be key. Hope she's OK! Remember, not everyone is going to get this - over half the population may escape!

Frasersmum - if you haven't already done so, see if there's a stronger antihistamine available for your son on prescription. My DD's last 2 summers have been transformed by better hay fever control. She loves sport, and as she's in good nick at the moment I'm hoping she can get as fit as possible in preparation for a hard winter.

She's recently had a paediatric referral and a complete change in asthma medication, and so far she's much better, but we haven't been through a winter on the new stuff yet.

I haven't had very happy experiences with asthma nurses - my DD was very undermedicated at the asthma clinic, and I was told her peak flow was fine, when it was actually worryingly low. More fool me for not knowing more about it myself . If you haven't already done so, get him a peak flow meter from the gp, find out what his reading should be, and monitor it regularly. It can be useful for predicting the onset of illness before symptoms start, and if it's really low it's hard information to give to the doctor.

Very helpful, thanks - will ask at surgery tomorrow re asthma nurse/trained practice nurse.

singersgirl am also in Barnes - had no idea (as suggested!) that an asthma nurse was available! Would that be Essex House or Glebe Road?

dd never uses Salbutamol, though she has a blue inhaler in case - except to open her airways prior to taking a puff of the preventer, to make it more effective. She still uses a spacer.

She also didn't get a flu jab last winter (dh and dd2 did: he's asthmatic, and dd2 has laryngomalacia) because she's never been hospitalized with asthma - and therefore not considered asthmatic enough, apparently

Not sure if the same will be true of this vacc, or of Tamiflu for that matter?!?

I'm also wondering how flu could affect dd2, whose lungs seem fine but who has a narrowed airway higher up. More questions for the docs...

Sidge If steroids take two weeks to work then should anyone who's got a preventer ready to start be taking it now anyway given how the flu is spreading? I've got a brown inhaler (used to be becotide last time I took it, now clenil something?) - haven't used one for about two years - GP said start if signs of upper resp tract infection. Am trying to work out if I should just start it now anyway. I'd hoped it would have an effect quicker than two weeks!

Will watch this with interests as I am worried about my DD2. She is only 15m but has had two cases in which she was taken to A&E for respiratory issues. The second time they've given her the salbutamol to help her and for us to keep. Third time it happened on holiday and the salbutamol did not relieve her and after a long night she was given and an injection of cortisone and the mask (donlt remember how it's called) and was told she had developed bronchiolitis.

As she is so young and it only happened 3 times no one has made an official diagnosis and we have been given the salbutamol just in case. We are not sure even if it is cold induced or allergy induced. They do not want to refer to asthma nurse or do an allergy test for the above reasons.

I am now worried about this winter. Sidge maybe you can advise.

Elibean - My DD & DH both get annual flu jabs in spite of never having been in hospital with asthma - it's possibly to do with the way budgets are managed, but it might be worth questioning this.

Sidge - DD's paediatrician also said that it's not worth increasing the preventer when a cold is starting as it takes a week or two to work (opposite of what gp advised). DD takes the preventer all the time, though.

I am keeping DS2 on his preventer even though he hasn't had an official diagnosis yet. When he doesn't have a virus/coughing, I'm not sure. His symptoms are really mild: he just seems more tired (without the preventer) and grumpy and pale. We're supposed to be doing a controlled trial without the preventer (until he's old enough to do proper peak flow meters) at some point to see how he is without it, but tbh am reluctant since we now have SF in the area. Am hoping to get an appt soon to discuss all this with the nurse. Would be grateful on other views for managing this as yet undiagnosed asthma too...

... nebuliser... that's what I meant

Lupus: Tired, grumpy and pale summed up my daughter before respiratory symptoms became much more pronounced last winter. She also used to become nauseous when she pushed herself too hard physically, even when her breathing was OK. When her asthma is controlled, she's the energetic and exuberant child that I remember of old.

It's very difficult when you have no diagnosis yet, but I think it's a good idea to discuss it with the nurse and see if you can be cautious with him now, then do the trial when the coast is clear.

Thanks, Pyrocanthus, thats helpful (re flu jabs).

I can see we're not the only borderline/mild-asthma family with plans that could be tightened up

Am seeing my own GP next week (unrelated) and will ask about all of it. And phone to ask whether there is an asthma nurse in the practise, or locally, we can see.

And, dd2 - who is 2.5 - is also a possible borderline case, as in the tired/grumpy/pale. She goes through phases, possibly hayfever linked, but as she has had very few chest infections (in spite of floppy larynx, and RSV bronchiolitis as a baby) we're really not sure. I have spacers, blue and brown inhalers, and a baby mask thingy (for dd2) all of which the GP sort of lobbed at me with instructions to try and see, at various times over the past two winters

Elibean - current advice is NOT to take the blue prior to taking the brown - 'opening up the airways' before having the brown is a bit of an old wives tale. The brown, if taken properly through a spacer, will be perfectly effective anyway. It also means you aren't taking salbutamol that you don't really need!

Protocols for giving flu jabs (i.e. seasonal flu not swine flu) seem to vary between areas but here it is recommended that if you are on regular inhaled steroids (not just salbutamol as needed) then you should have a flu jab. Hospitalisation is not a criteria. (But if you had been hospitalised for asthma you should be on a regular inhaled steroid anyway!)

DamonBradley it is incredibly difficult to diagnose asthma in a toddler as you can imagine, and most cases of baby asthma are now thought to be viral wheeze anyway which wouldn't necessarily respond to salbutamol/clenil anyway. Sometimes inhaled steroids help treat the episode but the jury is still out as to whether they should be given longer term. It might be worth asking your GP for a referral to your local hospital's paediatric respiratory clinic - paediatric specialist nurses and consultants see a lot of children with viral wheeze (as well as asthma) and will probably have more experience than the GP at the management of it.

What about people who have been told to start using their brown inhaler at the start of an upper respiratory tract infection - do you think they're doing the best thing waiting for signs they're ill, or would they be best just starting it anyway (or at first sign of swine flu in the local community rather than in themselves)? wwyd?

Well that's what I'm wondering - in the past I've been told to start taking it over the winter but never (till now) to wait till there are signs I'm actually ill. The thing is that my asthma is not very bad so it's a bit unnecessary normally and the last couple of winters I haven't used it. I'm not sure what to do now!

Yes, I think you're right about it depending on personal triggers and so on.