Astmatic 3 Year Old

My little girl has just been diagnosed with asthma. My husband and I have no history of asthma in the family so I am a little surprised she has it. We've been told to use a ventolin inhaler for now to control the symptons. What else will I have to do to minimise an attack?

Unfortunately the incidence of asthma is still increasing.


The doctor should take time to exlain in full to go through all the things you can do to reduce symptoms and treatment etc.


Although it is probably mild I would also suggest you go through a first aid course so that you are prepared incase of a serious attack.


Lynne 852-28490328

Matilda International Hospital

Hong Kong

http://www.matilda.org

Did you post once already and the post disappeared? (It seems I already responded to a nearly identical post but I can't find it.) I will respond because my daughter had asthma from an early age. My first advice is to find a specialist for asthma care. They are more up to date and have just a bit more sophisticated knowledge. There are two types. One is a pediatric pulmonologist. The other is a pediatric allergist. The pediatric part is significant because the types of meds and method of delivery is different for children. For instance, proper use of an inhaler takes training and practice, as well as make sure you have a "spacer" for her. For a three year old, I would think a nebulizer might be better. (You can buy one and keep it at home.) But also, you really want the lowest dose of of the medicine that has the least side effects, but you need a medicine that is effective for preventing the asthma, not just treating symptoms. (Proventil helps with symptoms but it has its own side effects and it is not a preventive medicine. But, on the other hand, some preventive medicines may also be inappropriate for a very young child.) In my personal experience, it just seeemed that the allergist we used was more sophisticated about how he managed our daughter's treatment than our pediatric practice. My second advice includes a quote from the American Lung Association: "If you can't breathe, nothing else matters." Keep emergency medicines on hand, but also if you ever have any doubt about "should I or shouldn't I" get help, err on the safe side. I made the mistake of calling a pediatrician's answering service one time, waiting for them to call me back, then while the nurse was on the phone "hemming and hawing" trying to decide whether to send me to the hospital, my child's lungs filled up with fluid and her lips and fingers started turning blue. (She was having an anaphylactic reaction to peanut.) Believe me, the ten minute ride to the hospital seemed to take forever. We were lucky we had an epi-pen on hand and that my child had the wisdom to use it on herself, mom was too stupid and slow that time. This leads to the subject of how important it is to treat allergies, if they are an underlying cause. The testing for allergies is fairly unpleasant (but not horrible). For this reason, our allergist recommended not to test until age six or seven. See if you can control allergy symptoms by getting rid of every possible cause of allergy in your house: aim for zero dust, zero dust mites (that means eliminating curtains or carpet, as well as plastic covers on mattresses and pillows), zero visible mold or mildew, zero feathers or animal dander, zero c*ckroaches, etc. Keep a food diary and notice whether any certain foods seem to trigger more nasal congestion or skin rashes. Avoid foods that are known allergens. Get a vacuum that has HEPA level of filtration as well as a HEPA room filter, and also keep the house / room at a good humidity (not too dry, not too humid). Your doctor can help educate you about these measures. If they don't work, your doctor can then discuss what kind of allergy testing and / or food elimination diet to try in order to sort out what types of allergens might be causing the asthma. Finally, avoid possible allergens religiously in the hope that the allergies don't get worse over time. Some people find help through homeopathic remedies. My daughter was helped by allergy shots she started at age 8 or so. I hope this advice is helpful. I think it's quite scarey when a young child has asthma, but the good news is that it is treatable. Oh, one other thing, teach her early about germs and not touching her face with her hands (which have been exposed to germs on doorknobs etc), and be proactive about treating colds. What would be a minor cold for one child would always turn into sinus infection / bronchitis / pneumonia for my child, simply because the allergies and asthma made her more susceptible. Hopefully your doctor will also be more proactive in this area and help you to keep her healthy.

My oldest daughter (the really allergic one) always had allergies, including to dairy and mildly to soy, but she did not have a full fledged asthma attack until one day when she was 7, we were in a pet shop. The owner put a big macaw on her arm, and she started wheezing, couldn't breathe, and got really faint (from lack of oxygen). That's how we learned she was allergic to birds! We had allergy medicines at home but they didn't act fast or specifically on the lungs like an inhaler does. That's when our doctor had us put together and "emergency kit" that we now keep close at all times. My sister's daughter on the other hand, had her first asthma attack as a baby and had to be hospitalized but then seemed to grow out of it as she grew older. When my third baby was born I did a consult with the allergist about how to avoid allergies. He gave the same advice as everyone else: avoid exposure to the allergens. When I was pregnant with the first baby, I drank 4 cups of milk daily and also ate peanut butter when I was having morning sickness. My oldest daughter was born with severe allergies to both of these. While pregnant with the second two, I abstained from dairy and peanut. My second and third babies did / do not have protein allergies.

Thank you very much Meiquoren, exyogi, Matilda and mummybee for all your tips.


My daughter went through an allergy test before they prescribed her the inhalers and we found out that she was also allergic to milk and eggs. And till the day of the test I was still giving her both. Guess things like that don't show up until later life when other complications happen. She has been given 2 inhalers, Frexotide which she has to take everyday and Ventolin which is only for emergency use. I was not advised to get a nebulizer though...do you think one is necessary? How much do these things normally cost?

I am a cashew nut allergy sufferer - serious anaphalaxis, can't breathe, epi pen -the works - and worry all the time that my problems with this will cause problems for my children.


But my daughter seems to be fine - she eats all sorts of nuts - including peanuts, no problem with dairy eggs, soy - flour - all the common allergens...I DID NOT abstain from the common allergy causing foods like peanuts and whatnot while pregnant, (except for cashews) and she is 22 months with no problems.


Why are there SO MANY more allergies it seems in HK - compared to where I am living now, in Seoul. When I taught in HK, 85% of my kids were allergic to something, and in Seoul, NONE of my kids are. Why are allergies on the rise?


http://www.usatoday.com/news/health/2006-03-19-allergies-cover_x.htm

Yes, at this age I think it's tough to find a good way to deliver the medicine. Also, I don't feel comfortable giving medical advice but I can pass along what I've learned over the years! Get yourself educated (the internet is great, look at American lung association, etc), but in the end your doctor is the one who really has the expertise to assess your individual situation and what recommend particular kinds of treatment. I think I was out of line to suggest that an inhaler might not do the trick and instill doubt, if your doctor assessed the situation in person and thought that it was okay. Also, if this asthma episode occurred along with a cold or bronchitis, it might even clear up and never come back. Be optimistic! But I'll put this info out generally for the benefit of anyone who might need to know sometime:

To use an inhaler properly, you have to completely exhale as far as you can (empty the lung), spray the thing into the air about 10 cm in front of your mouth, and then just afterwards breathe in the misted air as deeply as possible. If you put the inhaler directly in the mouth (as many people do), much or most of the medicine gets sprayed onto the membranes of the mouth instead of loosely into the air, so it never makes it into the lungs. To help with this matter of delivery into the lung, a spacer is exactly what green is talking about: just a chamber that collects the sprayed air and makes this process of capturing the medicine easier for anyone (not just a young child). A spacer is just a chamber that connects on one end to the inhaler and on the other end to the person breathing it. My child didn't need a face mask, she just used a spacer with a mouthpiece, but she was seven when she started using it. If your three year old can imitate blowing up a balloon, she probably can do the exhaling and inhaling needed to successfully use a spacer, if you help her with the timing of the spray. A nebulizer administers medicine in a slightly different and more thorough way. You put a liquid medicine (whatever you are using) into a chamber, then the nebulizer compresses air and sprays it through the medicine to create a very fine mist, which the child then breathes. A fancy mister. The child breathes the mist using either a mouthpiece (what my daughter used), a face mask (used for younger babies), or even a tent (used by desperate parents, including myself). The mist particles from a nebulizer are smaller and delivered over a longer period of time, so they go deeper and more thoroughly into the lungs resulting in a better treatment. The child has to sit there and breathe in the nebulized air for ten minutes or so, which can seem like an eternity to a young child. Our instructions for proventil in the nebulizer were to just use enough medicine until she got relief, maybe three or five minutes, not to try and use up the whole "dose" (proventil stimulates the heart and has unpleasant side effects). This opened up the airways. Then after the lungs were open, we would switch medicines to anti-inflammatory medicines (which are the preventive medicines). For these, we needed to use up the precise dose, so she was supposed to use the nebulizer for a certain number of minutes (some condensation from the breath goes back down into the mouthpiece, so you can't tell exactly how much has been inhaled). The nebulizer is also a pain in the rear. You have to take it apart and clean it each time, and it has to be plugged into a wall socket, and the child has to sit there attached to it to get the treatment. Because it delivers "stuff" very deep into the lungs, you have to make absolutely sure there are no germs in it. I think we kept two or three mouthpieces and tube sets (used to connect the mouthpiece to the air compresor) and boiled them after each use (two or three daily treatments at our worst, so we were boiling every day). We paid about $70 US for our nebulizer which we own. We kept it on hand for times when her breathing wasn't good enough to allow use of an inhaler (for times when she needed a deeper, more thorough treatment to even get the medicine into the lung). Having a nebulizer on hand saved us several trips to the hospital. Speaking of my phrase above: "breathing wasn't good enough," here is something very important. Do you know how to measure quality of breathing? You measure breathing capacity by using a "peak flow meter." A peak flow meter is a tube the child blows into as hard as they can. Based on how much air they are able to move through the chamber, a little measuring stick moves up based on the force of the wind. The child gets three tries to exhale with enough force to push the stick up as high as possible. You keep a daily record of what the highest number for that day is. This is really useful. You will begin to see patterns based on medicines and exposure to allergens, and it also gives an objective measure of how good or how bad the breathing really is, helping you to decide how to treat. You will carry your peak flow diary to the doctor every time you visit, and the information will be used to help decide how well controlled the asthma is. The doctor will help you determine the ideal "peak flow" number for your child (the smaller the child, the lower the number will be naturally because they can't exhale as hard naturally). If you ever call the doctor in the middle of the night, one of the first questions will be, "what is the peak flow number?" because this gives the doctor (and you) an objective measure of how bad this particular asthma attack (or bronchitis) is, based on numbers unique to what is normal for the child. It can also be used to help in deciding whether to transport the child to the hospital: a number below a certain percentage of ideal would mean "yellow alert," watch closely, and another number would mean "red alert," get the child to the hospital. Well, hope this helps. I hope your child's asthma is mild and will go away with no future worries whatsoever. I have an interesting P.S. on my own child's asthma. We were very worried about moving to China because of air quality here. But there's no pollen here! My daughter's allergies are related to food and pollen, not the large particulate matter that is the root of most of the air pollution here. So in our beautiful green home, with lots of trees and grass and birds, she had many allergies. The asthma largely went away in this city where there are so sources of pollen even though the pollution is so bad!!

Wow that's a long post but I hope the info is useful. Whew.