Update in #23: give ds Qvar or albuterol for asthma?

[JustMe]

In a previous post, I asked about ds' asthma, and it seems everyone really thought a maintenance med (which in this case would be Qvar) is best for their child with asthma. I went to a new dr (actually just switched him to dd's dr) and got a prescription, but I monitored his night time cough (the only symptom at the time) and found it had really gone away. This went on for a few weeks. I also talked to a friend of mine who does health care with kids in schools. She said she agreed/knew that the maintenance med route seems to be best practice these days, but also understood that since I have not seen what asthma looks like for ds, it might make sense this year to get a feel for what that was like. She said I could always use the albuterol if I needed to, and I would get a sense of when he has his symptoms etc. I completely hear what everyone said about not wanting to get into a bad situation and other reasons why maintenance med is good, otoh giving him meds if its not necesssary in his case (since his asthma really does seem very seasonal and he is fine the other times) is a worry.


Well, yesterday when I picked him up at school, I noticed he was coughing a lot. This morning he is really coughing a lot, so I know I will need to give him something. So, should I start him on Qvar (which I assume would mean I continue through the winter) or just do the albuterol and see what happens? I hope you guys dont feel like I am not listening to you and you have to keep telling me the same thing over and over again (use the maintenance med) for no reason, but it just really is different when you have not seen the symptoms and dont know what it is like for your dc. I mean I know that there would have been no reason to have him on anything the first 3 months he was here; he had no symptoms at all...so, the question really is start the mainteance med and continue through about March I would think (pros are that it seems to be best practice, safest?, etc) or just do albuterol (pro is that this would give me a chance to get a really good feel of when asthma is really an issue for him). Also, a local friend of mine whose dd has asthma that may be similar to ds' says that Feb is really the biggest problem for her, and we are getting closer...

ETA: I just gave him albuterol because he kept coughing and I figured it was probably bad enough for him to have that...so, any further advice about how to proceed is appreciated.

[keliahmom]

If he's still coughing and you haven't given him anything yet, I suggest you give him the albuterol to relieve the coughing and help him breathe better. Starting the QVAR won't help him with the immediate symptom of coughing, but the albuterol will if it is asthma.

Don't know about the seasonal thing, so I can't advise you on that. I have asthma and am on QVAR all the time, with the albuterol if I start coughing.

HTH

[egoldber]

FWIW, albuterol and Xopenex (the bronchial dilator type rescue meds) do almost nothing for my older DD's asthma. The only thing that works for her is the preventative meds.

I know you want to avoid that, but I would strongly encourage you to talk to an asthma specialist. I think they will ease your fears and know what the best practice is.

ETA: You can give albuterol every 4 hours as needed. I often push that to every 3 during the day because she doesn't get it over night. We had to switch to Xopenex (much more expensive vs albuterol) because albuterol gave her a racing heart and made her pretty jittery. This is a common side effect.

[JustMe]

Thanks, I did give him albuterol and we will see what happens. From what I have been told, albuterol does help him so I should not have to worry about that. The ped. did say she would consider allergy testing, so I will e-mail her about that and see if I can get a referral to a specialist.

[bubbaray]

I would not do just albuterol. Our asthma plan is that if we have to give DD#1 albuterol more than once, our ped. asthma specialist wants to see her back. He does not want her taking it, even if she has a cold. He wants the preventative meds to do their job, so if she needs albuterol, the preventative dose is not adjusted correctly.

Personally, just using albuterol for diagnosed asthma does NOT seem like it is anywhere near approaching best medical practice for asthma. I'm no dr, but we've been through the ringer on the asthma front and every.single.dr we've been to has warned us that asthma that is not properly treated in pediatric patients leads to lung scarring.

OUr specialist tells us that the risks of the drugs are outweighed by the risk of lung scarring.

[egoldber]

Personally, just using albuterol for diagnosed asthma does NOT seem like it is anywhere near approaching best medical practice for asthma. I'm no dr, but we've been through the ringer on the asthma front and every.single.dr we've been to has warned us that asthma that is not properly treated in pediatric patients leads to lung scarring.

OUr specialist tells us that the risks of the drugs are outweighed by the risk of lung scarring.

Exactly. And these are relatively recent finding which many peds and non-asthma specialists are not aware of.

[Gena]

My son is on both QVar and albuterol for asthma. they are different meds and serve different purposes.

Albuterol is for asthma attacks. For my son, his attacks take the form of coughing fits, especially nighttime coughing. Sometimes he has wheezing attacks, but not usually.

Albuterol will stop the current asthma attack, but it will not keep future attacks from happening and will not stop the lung damage that can result from asthma attacks.

Qvar is a maintenance or "controller" medication and lessens the frequency of attacks. Less frequent attacks means less less chance of lung damage and less pain for my son. This is why it is important to use the controller medication as directed.

[JustMe]

Thanks everyone! I have e-mailed the ped for a referral to an asthma specialist and we shall see...my hopes are not high that ds'insurance will cover it, but I may look into paying out of pocket if it is that important. Okay, as I said I did give him albuterol for right now and should probably start the Qvar. Does Qvar (or other maintenance meds) actually keep future attacks from happening (see quote below).? Also, does anyone do Qvar or other maintenance med only seasonally? I know winter is the time for ds and he was totally fine during the summer and fall.

Albuterol will stop the current asthma attack, but it will not keep future attacks from happening and will not stop the lung damage that can result from asthma attacks.

Qvar is a maintenance or "controller" medication and lessens the frequency of attacks. Less frequent attacks means less less chance of lung damage and less pain for my son. This is why it is important to use the controller medication as directed.

[bubbaray]

Qvar is a maintenance or "controller" medication and lessens the frequency of attacks. Less frequent attacks means less less chance of lung damage and less pain for my son. This is why it is important to use the controller medication as directed.

Saying this gently, but my understanding is that a correctly chosen and dosed preventative/controller med will ideally prevent ANY asthma attacks. The first question our specialists asks at our routine visits is whether DD#1 has had ANY use of albuterol at all. When I say "only at night if she has a cold", he reminds me to UP her preventative as soon as she shows signs of a cold and to call his office if we have to use albuterol.

Also Qvar is a very mild preventative. From speaking with my own pulminologist (who took me off Qvar), in CHILDREN the current best practice is to start using the highest dose preventative (Flovent) and work DOWN to the dose/medicine that manages the asthma (with no need for albuterol). In adults, its the reverse -- start with the mildest preventative and work UP to the med/dose that works. This is because they know now that the risk of lung scarring is highest in young children. Lung scarring is for life -- once a child has it, there is no way to get rid of it and it can affect their lung function forever. I have widespread lung scarring myself now and it is really impacting my breathing.

JMHO

[Gena]

Thanks everyone! I have e-mailed the ped for a referral to an asthma specialist and we shall see...my hopes are not high that ds'insurance will cover it, but I may look into paying out of pocket if it is that important. Okay, as I said I did give him albuterol for right now and should probably start the Qvar. Does Qvar (or other maintenance meds) actually keep future attacks from happening (see quote below).? Also, does anyone do Qvar or other maintenance med only seasonally? I know winter is the time for ds and he was totally fine during the summer and fall.

In previous years, we did the controller med seasonally. At that time he was on Pulmicort in the nebulizer and we used it from October to May. We started this when DS wad 10 months old. When DS was 5 we took him off the controller med completely. He has not had asthma symptoms for over a year so we thought he had outgrown the asthma.

This past summer, DS started getting asthma attacks in the summer, which he had never had before. We (his doctor, DH and I) decided to switch DS from using the nebulizer to an inhaler with a spacer. This is when we started him on the Qvar.

I understand how frightening it can be to put a young child on a steroid medication. But what I have learned about asthma and my experience with my son has shown me how important and valuable these medication are.


You may find these articles helpful:

http://kidshealth.org/parent/medical...ontroller.html

http://www.aboutkidshealth.ca/asthma...yID=AS-nh03-01