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  #1  
December 27th, 2010, 11:31 AM
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Join Date: Dec 2010
Posts: 8
Hi Everyone I just found this great forum, and would like to compare notes.

My 2.5 yr old daughter was diagnosed earlier this year after a couple hospital trips and flares in subsequent months. We are connected to an asthma/allergist now (she also has severe peanut allergy and mild eczema) and we have albuterol and budesonide at home for when flares arise - she's had four flares in the past six months. they seem to be triggered by allergies and/or a cold, this week was due to a cold. These last couple flares we've managed without any oral steroids.

We visit the asthma/allergist again in 2 wks to discuss maybe going on singulair or something similar.

Would love to have insight on a couple questions:

1- How proactive should I be with starting budesonide and/ or albuterol? I know B. is more preventative/stabilizing so I've toyed with starting that when she first gets any cough or runny nose. And last night I gave Albuterol right before bed (though she wasnt in distress) to help her night go better. Comments?

2- When do I go see the pedi for a lung check? I use a stethescope at home (my training is in physical therapy so it's not like I'm a RT but I know a bit about lung sounds) so I can hear very minor wheezing but i don't feel confident in identifying pneumonia or anything. She rarely gets a fever. During this last episode I haven't called the pedi since her wheezing/coughing has not been too bad. Comments?

3- Do non-asthma toddlers get out of breath when they have stuffy noses (like trouble finishing a sentence after running through the house) or is that asthma flaring up already?

Thanks everyone! Would love to hear insights and what your action plan is like, especially for toddlers!

Jessica
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  #2  
December 27th, 2010, 02:19 PM
BusyMom4's Avatar Veteran
Join Date: Oct 2010
Posts: 217
Hi and welcome I am the mom of a little girl who has several health issues, one of them being asthma. She is a former 33 week preemie and was diagnosed with asthma at 23 months old. She will be 6 years old in 2 months and still struggles with her lungs.

As far as starting Pulmicort (Budesonide) it depends on her needs and the severity of her asthma. I would start with something easier to use like Singulair. My DD is on Singulair and Flovent (Inhaler version of Pulmicort) and the Singulair is so easy to use. She has been on it since she was 24 months old. Many many asthmatics get enough prevention with Singulair (which is non steroid) that they dont need to go on a daily inhaled steroid. Singulair works better at preventing asthma symptoms than allergy symptoms so adding Zyrtec or something similar may help if she is allergy induced. The idea is controlling the asthma symptoms effectively with as few medications as you can.

Using Albuterol before bed when she has been sick or wheezing is perfectly fine. I do this sometimes. In fact, part of our prevention plan is 2 puffs of Ventolin (Albuterol) before exposure to any triggers such as activity or cold weather. It depends on your childs triggers. When she has been coughing and/or wheezing and is heading to school, I will often give her Ventolin so its less likely she will need her inhaler at school.

Go to your ped anytime you think you need to. I too use a stethoscope, but cant self-diagnose anything LOL. The stethoscope is invaluable to us though, because you can hear the wheezing with it before it gets bad enough that you can hear it without, know what I mean? After using it for years like we have you are able to identify the 'tightness' you hear the doctor talk about too. We also have a peak flow meter (your DD is much too young for this) and a pulse oximeter that are great. I have a detailed asthma action plan given to us by our pulmonologist and it says to seek medical attention if:

* your medication is not helping
* your breathing is very difficult
* you cannot walk or play
* you can not talk easily
* peak flows below 50% of personal best

In the event of this we are to use 4 puffs of Ventolin every 15 minutes up to a total of 3 times.

Non asthmatics should not get out of breath when they have a stuffy nose. That is an asthma thing, and it means she needs a rescue treatment because she is having trouble breathing. She should be able to finish a sentence.

I can share my DDs asthma action plan with you if you like, but Im not sure if it will help much since we use inhalers instead of the nebulizer.
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  #3  
December 27th, 2010, 07:57 PM
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Join Date: Dec 2010
Posts: 8
Thanks BusyMom! Yes I would love to hear your action plan, I'm trying to take in a lot of stories so I can learn my way around the vocabulary and how different age kids present/change.

This current flare is pretty much over, her cold is still winding down but there's no more wheezing and hardly any coughing, even at night. Is it weird that I never felt the need to take her to the pedi this week? It was her mildest flare yet (at least partially because I give the neb earlier each time) and I never had to do albuterol more than every 6rs all week. And now that it's over I feel like going straight to the end (taper albuterol and do budesonide daily x 1month is the current plan).

At our asthma/allergist appt next week I'm asking his opinion on starting singulair and also a recommendation for a new pediatrician... ours is farther away since we recently moved and also I feel he's not taking the asthma or her peanut allergy seriously enough.

At what age do kids start "getting" how to do an inhaler?

Thanks again and any info/ stories are very very helpful since this is all so new!!
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  #4  
December 28th, 2010, 10:12 AM
BusyMom4's Avatar Veteran
Join Date: Oct 2010
Posts: 217
I dont think its 'weird' that you didnt call the doc over her last flair up. As you get more comfortable handling her asthma, you will make fewer and fewer calls, however, when you do see the doc, be sure to tell them about the flair up so they are aware of how often she is needing rescue meds. This is important in finding a prevention plan that works.

If you feel her ped is not taking her condition seriously I too would switch. You need to be comfortable in the care your child is receiving. We also moved 2 hours away from the doctors who had cared for Nyla her entire life, and it was tough to find new doctors and spell out what problems she had suffered with her entire life.

You can ask her pulmo if she can use the inhaler now. Most like to wait until they are about 4 years old or so, but since you use it with a chamber, some will let them use it anytime. I like it so much more since it delivers the same medicine in 6 breaths verses 20 minutes with the nebulizer!!

OK, this is Nylas asthma action plan. We have 3 steps. The first is 'Routine Therapy' This is what we do every day, no matter how good she is doing, this is what we do. This is all written down so we are never left guessing. We stick with routine therapy if she is:

* breathing easily
* not coughing or wheezing
* not short of breath
* able to work, play, and sleep easily
* peak flows 80%-100% of personal best

Routine Therapy:

* Flovent 110 one puff twice daily
* Singulair 4 mg tablet once daily

Take quick relief medicine:

* Ventolin 2 puffs 5 prior to exercise or unavoidable trigger exposure


Next is 'Step Up Therapy.' This is what we do during a flair up. We move to step up therapy if she is:

* coughing
* wheezing
* short of breath
* having difficulty breathing during activity
* feeling chest tightness
* waking at night with symptoms
* peak flows between 50%-80% of personal best

Step Up Therapy:

* Ventolin 2 puffs

Monitor Symptoms

* If symptoms resolve within 15 minutes return to Routine Therapy
* If symptoms persist or return within a few hours take up to 2 more doses of Ventolin at 15 minute intervals and repeat dose up to every 4 hours thereafter
* Increase Flovent to 2 puffs twice daily for 5-7 days
* If symptoms show no improvement after treatment call a doctor or seek medical attention

Last is 'Get Help Now!' LOL that is really what it says, or the red zone treatment. So, we seek medical attention if:

* her medicine is not helping
* her breathing is very difficult
* she cannot walk or play
* she cannot talk easily
* her peak flows are below 50% of personal best

Take quick relief medicine:

* Ventolin 4 puffs every 15 minutes up to a total of 3 times
* Start Orapred for 5 days

Seek immediate medical care or call 911
Do not try and treat severe symptoms yourself



This is Nylas asthma action plan. I know its long, but we are never left guessing what to do!! She also takes prevacid because she has reflux and aspirates. Being on the prevacid and stopping the aspirating has helped her lungs quite a bit. She also has chronic sinus disease and a very poor immune system and is failure to thrive, so this has been a long uphill battle for her. She is doing quite well now though (all things considered that is!!)

Let me know if you have any other questions, Im happy to help if I can. I know how scary and frustrating this can be
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  #5  
December 28th, 2010, 02:33 PM
JessP's Avatar Lovin life and family
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My DS has been using a nebulizer since 6 months although only diagnosed with asthma at 3 yo. We start the nebulizer at the first sign of a runny nose. We also do singular once a day. This has kept us with just colds and no bronchitis. Before this (started this method last winter) we had bronchitis 3-4 times a winter . It was miserable for the poor guy. We do the inhaler as needed for wheezing, coughing in between neb treatments. He has an inhaler at school just in case, although they have never had to use it. I never thought about the wheezing or shortness of breath with DS since that is just how he has always been. But this last spring my MIL (a PA) made mention of it while he was running around outside. It made me realize we should probably use the inhaler more than we do.
Jeremy hated the masks for the treatments at first but now he is used to it and knows that its what makes him feel better. Colds and coughs don't last weeks or months anymore which is a blessing. It took a while for him to get used to it but now its great. I don't go in for every flare up anymore. I used to have to go in all the time but now that we have a plan we only go in when we can't get him under control. We only had one real asthma attack in the last 4 years and we think we found the cause but it was still scary. I didn't know for sure what to do.
Do you have the mask/tube for the inhaler?

Welcome to the board. Feel free to poke around, ask questions and make yourself at home. This isn't a busy board but we are here if you need us .
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  #6  
December 28th, 2010, 07:34 PM
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Join Date: Dec 2010
Posts: 8
"Do you have the mask/tube for the inhaler?

Welcome to the board. Feel free to poke around, ask questions and make yourself at home. This isn't a busy board but we are here if you need us .[/QUOTE]"

Hi JessP thanks! Re: your question above, not sure what you mean... all we have is the neb and its mask. We did the pipe thing for a while but I finally got her wearing the mask and since we've done it more days than not the last 6 months, she doesn't give it a second thought LOL
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  #7  
December 29th, 2010, 06:06 PM
JessP's Avatar Lovin life and family
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We have a mask for the inhaler and for the nebulizer. That is somewhat easier than just the tube imo . Glad she isn't minding the mask.
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