Allergy & Asthma Network Mothers of Asthmatics (AANMA)

1. Our one-year-old son has asthma. How do I know when I should treat his symptoms at home with more breathing treatments vs. take him to the hospital?

The first step is to get a written asthma action plan from your son’s pediatric allergist that provides this detailed information. There are no one-size-fits-all answers. But there are some general rules of thumb:

  • When in doubt, call your doctor or go to the emergency department.
  • Keep track of medication names, doses and the time he took them. Do not give any medication more frequently than prescribed.
  • Make sure the nebulizer mask or holding chamber mask fits snuggly against your child’s face to ensure the dose of medication is inhaled and not released into the air.
  • If symptoms do not respond within the time expected, or if you notice any of these danger signs, seek medical attention immediately:
    1. His skin is dusky or off-color
    2. He is lethargic and weak
    3. The skin around his neck, shoulders and ribcage draws in with each breath
    4. His stomach heaves when he breathes
    5. His lips are pale or have a blue tint
    6. He cannot stop coughing, gagging or wheezing

2. My daughter is five and was diagnosed with asthma two years ago. She takes Pulmicort twice daily, albuterol when she needs it for cough, Singulair and Zyrtec. She still has attacks at least twice a day and coughs throughout the night. She can’t do the things kids her age should be able to do! I don’t know what else to do. We have even considered moving, thinking that might help.
Before packing your bags, take a trip back to your daughter’s pediatric allergist or other asthma care physician. It’s time for you both to do more investigation. If the current treatment plan isn’t working, it’s because the cause of symptoms has yet to be identified and treated or removed.

Do you use a daily symptom diary such as AANMA’s AsthmaTracker? It’s the best way to detect trends or patterns to symptoms and their response to medications. Your daughter is also old enough to use a peak flow meter, a basic measure of lung function. It takes just 30 seconds each morning and evening, but helps you establish a day-to-day picture for your physician, as opposed to relying on memory from one sick visit to another.

Another do-it-yourself initiative is to use AANMA’s Indoor AIRepair Kit to identify and eliminate allergens and irritants hiding right under your nose. The room-by-room guide offers low- and no-cost solutions; based on the nighttime coughing, start with her bedroom and her bedding. Dust-mite-proof encasings for the mattress and pillow may do the trick.

If her symptoms are due to gastroesophageal reflux (GERD), raising the head of her bed slightly and using a medication specifically for reflux can also help. Have food allergies been ruled out? Does she have a smoldering sinus infection or postnasal drip? Has she been tested for environmental allergies?

Until you get to the source of the symptoms, they will continue. What you both need is a good night’s sleep.

3. My son is six years old and was diagnosed with asthma two months ago. He takes Singulair, 2 puffs of Flovent twice daily, and uses his albuterol inhaler every day. Despite all the medication, however, he is still coughing and wheezing every day. Are these normal symptoms that my son will always have? It drives me crazy because I don’t know what else to do for him.
Daily coughing, wheezing and shortness of breath are never normal for any child or adult. By this point, his symptoms should be responding better to treatment. Since they are not, it’s time to look beyond the obvious symptoms to figure out why he is not better.

A trip to the pediatric allergist for testing will identify allergens and/or foods that might make him cough.  Use AANMA’s Indoor AIRepair Kit for low- and no-cost ways to eliminate allergens responsible for symptoms. Make sure your son is using a valved holding chamber along with his inhalers to ensure the medication reaches his airways and not his mouth or stomach. If symptoms continue to persist, don’t give up. There are many causes of asthma, and figuring things out takes time and a working partnership and open communication among your family and medical professionals. But once you figure out his unique formula for success, you’ll know it because life is so good, he’ll rarely need any medication!

4. For at least five years, I’ve been using inhaled corticosteroids – two inhalations twice a day. During spring and fall, I use steroid nasal sprays. I haven’t had asthma symptoms for more than a year except when I try to stop or cut back using the inhaled corticosteroid.  I’m 23 years old but I get hot flashes and am always exhausted. I can’t lose weight. I even went to a counselor thinking I was depressed (I’m an emotional wreck) but medication doesn’t help. This is not the real me. What is happening? I feel like I’m in a vicious cycle. HELP!

Inhaled corticosteroids taken at high doses for prolonged periods can suppress or shut down your body’s own production of hormones produced by the adrenal gland and result in the symptoms you describe.

Your allergist or pulmonologist can take blood tests to determine how well your adrenal glands are functioning. Adrenal suppression is serious; it is painful and it can take a long time to wean off inhaled corticosteroids safely. But the good news is that your adrenal glands will slowly but surely start functioning well again.

There are a variety of inhaled corticosteroids available today; some are less likely to be absorbed into the bloodstream than others. When using a daily inhaled corticosteroid with or without use of other topical corticosteroids, make sure you are closely monitored by the asthma specialist until such time that you no longer have inflammation.