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Asthma

CVA Asthma

12/09/2010

Question:

i have a 4 year old son who was diagnosed with cough variant asthma but he is on advair 45 when not sick and advair115when sick but every time he gets sick he has the worst coughing fits to where he can stop at all till we go to the hospital and he gets the steroid in him but we tryed everything he been tested for all allergys and he was fine adnoids were fine i dont no what to do im so worried about my son can anybody help PLEASE!!!!!!!

Answer:

This sounds like a frustrating situation. When I see a child with this story in the office, the evaluation starts with checking to make sure the diagnosis is correct. If it is, then I check to make sure the medications already prescribed are getting to the lungs (using the spacer properly? Using the medicine even on good days?) I want to know if there are symptoms between the bad spells, and how quickly more medications are started once the child is ill. I also look for "other stuff" that may be irritating the asthma (like chronic sinus disease.). 
Finally, I change the plan.  Your child may need to use stronger daily medication, or change the "acute" plan. (I don't find switching control medications help much. Albuterol needs to be started early, and if it's failing, adding oral steroids quickly can avoid illness that requires a hospital visit.) Go back to your doctor and ask for an asthma review. If your doc is out of ideas, it may be time to see an asthma specialist or a new asthma specialist if you've already tried that.
This sounds like a frustrating situation. When I see a child with this story in the office, the evaluation starts with checking to make sure the diagnosis is correct. If it is, then I check to make sure the medications already prescibed are getting to the lungs ( using spacer properly? Using the medicine even on good days?) I want to know if there are symptoms between the bad spells, and how quickly more medications are started once the child is ill. I also look for "other stuff" that may be irritating the asthma (like chronic sinus disease.). Finally, I change the plan. Your child may need to use stronger daily medication, or change the "acute" plan. (I don't find switching control medications helps much. Albuterol needs to be started early, and if it's failing, adding oral steroids quickly can avoid illness that requires a hospital visit.)

Go back to your doctor and ask for an asthma review. If your doc is out of ideas, it may be time to see an asthma specialist - or a new asthma specialist if you've already tried that. 

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Response by:

Elizabeth D Allen, MD Elizabeth D Allen, MD
Clinical Associate Professor of Pediatrics
College of Medicine
The Ohio State University