steroids and nebs - I need advice

Hi, I'm new to this forum.

Am at my wits end over my son's asthma management, he's coming up to four yrs old.

His only trigger seems to be a cold/bugs and he's on fluticazone, currently 150mg twice a day and montelukast once a day.

We've bounced into hospital 8x this year. Normally once a month. The only clear months were June to Sept. Now he's started nursery in a school he's picking everything up and we were in 3x Oct to Dec.

I'd really appreciate advice on the following:

*He's given a 3 day course of prednislone every time he goes to hospital. I assume this lowers the immune system and makes him more susceptible to infections when he gets out. I wonder how long i should leave it before sending him back to the nursery to catch another bug?!

*He's on a high dose of inhaled steroids but this doesn't stop him having hospital admissions. What's the point?(docs don't have much to say on this subject).

*He responds a lot better to salbutamol nebs than a spacer once he gets a cold. I'd really like one at home. Then I wouldn't have to take him to hosp for them. They say they don't give them out any more and also some say if my spacer technique was good the two are the same. This doesn't seem true at all in my son's case and my spacer tech. has been checked and approved loads of times by health profs.

Sorry for the long post but can anyone shed any light on all of this?

Thanks

Jane

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It is true that prednisolone (the steroid) lowers the immune system but it seems that people with asthma are just generally more susceptible. Have you tried a multi-vitamin everyday to try and boost his immue system? I would say about a week off nursery but try and be aware of whether any other children have particularly nasty bugs as this may be a time to keep him off. Of course avoiding picking things up at nursery is very difficult, but maybe seek advice from your doc.

Although they may not seem to do a lot, you may be surprised. Even though the doses seem very large, it's actually very small and as it goes straight into the lungs there is few side effects. It might be worth asking for an action plan, so if your child has a cold you could step-up his preventer dose and this may prevent hospital, but speak to your GP/consultant first.

Lastly, there's no chance of a home neb. They are very rarely given out these days, and when they are only when people have no quality of life at home without them. There is evidence to say that 10 puffs through a spacer = a nebuliser, but it's effectiveness varies from person to person. The danger of having a neb at home is that it seems a miracle cure. You give it to your son when he is poorly and although he may seem to miraculously improve the reality is he could be getting worse. A lot of people keep giving nebs and by the time they do go to hospital they are very very poorly. Another thing which almost all paediatric doctors say is that if a child is ill enough to need a nebuliser they need to be in hospital and i would definitley agree. It's better to be on the safe side where dr's and nurses can monitor the child.

Are you under a specialist respiratory consultant? If no i would definitely suggest asking your GP for a referral.

I hope you have a good asthma-free christmas!

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Thanks!

Thanks very much for your response anzharry.

My son's got two paed. resp consultants. This is because he wound up in intensive care at a world famous children's hospital(!) after GP and local hosp failed to pick up and manage his asthma.

I refused to go back to our local hosp following the itu experience and he has a consultant at another one quite near. She's okay but doesn't review him very often. She wanted to put him on 400mg of fluticazone daily, I refused.

His plan is that I up his salbutamol to 10 puffs and when I'm giving it more than 4 hrly we have open access to the children's ward, phone them up to say we're on our way and then go in normally for an overnight stay and nebs.

I've also got a letter from the consultant with his plan on it in black and white which I carry round in my handbag and show to receiving nurses/docs.

I would recommend this to anyone as it's a sure fire way of not getting fobbed off/ sent home too soon/given the wrong treatment. It's also good when you're on holiday etc for other hosps in the case of emergency.

I would prefer, as you suggest, to up to steroid inhaler at the first sign of a cold rather than give so much every day. We've done this with his 125mg one before but it hasn't done any good.

I think Again, as you suggest I'll try to get the nursery/school to let me know if there's a nasty bug doing the rounds before sending my son back.

I do give him multi vits, a healthy diet and even started echinacea(yep, I know there's no scientific evidence...)

Touch wood we are having a healthy xmas so far as I hope you are.

Happy new year!

Jane

[angievere]

Hi Jane, I really sympathise as we have been through the same with my (now teenage) son when he was young, and still do. Colds are his trigger (and mine too) and unfortunately nurseries and schools are hot-beds of colds and viruses. And the autumn/winter terms are the worst for us.

As your son is only four, I would not worry too much about how much school he misses and I would be inclined to keep him at home to allow him to recover.

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nursery attendance

Hi angievere

Thanks for your response and sorry to take so long to reply. I agree that it would be best not to put pressure on my son to return to nursery when I feel he needs to recuperate, but there is a new post on this site which shows nurseries do take a dim view of long absences.

I have written to the head teacher as I feel the school secretary is unsympathetic and I don't want him 'blacklisted'before he even gets to reception.

[angievere]

Hi Janecassi, Thanks for reply. I have added to the post on School Attendance. But I would just like to say children can't be blacklisted for poor attendance. It depends on the school's admissions policy but generally there are 2 main admission criteria - catchment area and siblings at the school. Ill health does not come into admissions at all and if there is any hint of that happening, I would complain long and hard to all and everyone!!