Another trip to A&E with my 4 year old son

[Nsign7]

So just needed to rant a little....

I posted about 2 weeks ago when my son caught another cold resulting in a visit to the out of hours clinic and a 5 day course of pred (5th dose in 10 months). The GP upped the dose of the preventer inhaler to 2 x 2puffs 100mcg Clenil and we were hoping to see out the year with no further episodes.... How wrong I was..

He was off school yesterday with a cold and started coughing overnight due to a post nasal drip. We had already started the reliever dosage as per the asthma plan but his condition deteriorated today as his wheezing increased and he became more breathless.. We decided to take him into A&E as we live very close to the local hospital. While there his temperature spiked to 39C indicating a viral infection being the likely suspect for this exacerbation.

So here we go again, nebulised Salbutamol followed by 3 hours of monitoring and another course of Pred, now the 6th in 10 months. Viral bronchitis to blame which I suspect he caught while at school this week and probably more prone to infection due to lower immune system from the pred the previous week...

At least we got a referral to the Respiratory team at the hospital.. I had thought that his asthma was more episodic viral wheeze which would get better with age but now I'm not so sure anymore.. I suspect the next course of action will be the addition of Montelukast. Anyone had any experiences with young children and this treatment?

It was so sad to see so many young children in Pediatric A&E for wheeze and breathlessness.. Some kids were waiting for 4 hours to be triaged.

Rant over.. Hope you are all keeping well..

[Chip_y2kuk]

I have no experience of children on montelukast but I take it (of a morning and not nightime like it says on the packet,by agreement with doctor) and it has made a difference whether it's enough of a difference I'm going to keep taking it is a different matter (I'm already on lots of other add-on therapies)

[TSP2120]

Hi, my son was started on the granules aged 3, and went to the 5mg chewable tablet at 5. He initially had nightmares the first few weeks, but these calmed down. Dr suggested taking in the the morning to prevent this unwanted side affect. Main plus point for us was that he became less ‘sensitive’ to the morning and evening air, as school runs were a particular problem.

[Nsign7 in reply to TSP2120]

TSP2120, glad to hear that Montelukast is working for your son. Out of curiosity, when was he diagnosed with asthma and what tests if any were carried out? Was it viral only or other triggers in addition. Was Montelukast prescribed only when symptoms started or continously?

[TSP2120 in reply to Nsign7]

He was ‘officially’ diagnosed at 4 although he had been started on preventers and montelukast at 3. Montelukast is continual treatment as one of his ‘add in therapies’. It wasn’t until his second admission that he was picked up by his resp consultant.

He had his peak flow measured, they attempted spirometery, bloodwork and more recently FeNO. Because we tended to end up on the ‘pred merry go round’ where we’d clear the asthma symptoms up with the steroids, but then would catch another viral and so kept going around in circles, they tested his immune response and did top him up with Prevenar13 which dramatically improved the winter asthma/viral infections.

His main trigger at 3/4/5 was viral infections. As he’s got older we have become aware of his other triggers such as certain squashes (dilute drinks) hay fever was a particularly bad one this year, weather changes, emotions etc.

[Nsign7 in reply to TSP2120]

That's interesting. We are at a similar point right now although he's hasn't needed pred every time he's caught a cold. Sometimes we've been able to control with the asthma plan but the two most recent episode were only a week apart. I'm wondering whether the previous 5 day course of pred had lowered the immune system enough to be susceptible to a chest infection. I recently read an article in the BMJ about the efficacy of pred for viral induced wheeze for pre school children who exhibit wheeze only when they are affected by viral infections and are fine at other times.

We decided to withhold the pred to see whether he would recover with just the antibiotics for the chest infection. Interestingly, he is recovering at the same rate without the pred as he did with the pred the previous time.. Just waiting for the the respiratory referral now and we can look at further testing to determine if there are any other triggers.. Thanks for the feedback...

[TSP2120 in reply to Nsign7]

Your welcome, anytime! It’s not uncommon to be prescribed back to back pred, we were told that they count it as one course for the same exacerbation as some courses arent long enough to clear some flare ups.

For us, VIW was for the first few years and his asthma has changed as he’s gotten older; from clinic letters he’s had Atopic, VIW, Severe, & Cough Variant asthma! He hardly wheezes at all now and will normally become very breathless and tight chested, with nocturnal cough.

The referral into resp was the best thing we ever did, he was seen in 6 weeks, and had tests previously mentioned, they also sent him to SALT, which confused me, but they did a video fluoroscopy and found slight sync issues with his swallow, they also did a MLB (under sedation) to check his airways. Good luck, as it sounds like your navigating the system just as we did, and it can sometimes be very frustrating.

[Tree20862]

I have had wheezing episodes when sick since I was 6 months old. I'm 52 years old now. I have been on a lot of asthma medication and inhalers over the years. Montelukast helps. In me, I'm not sure how. The 2 times my doctor tried to stop it, I had sinus problems, asthma problems or both. I have been on it for a while.... More than 10 years.

I know it is being used more often.

My asthma is better controlled right now. Hopefully your son's will be soon, too.

[Nsign7]

Thanks for your comments.. Since we identified a house dusty mite allergy and put in place preventative measures such as anti allergy bedding, etc, my son has been a lot better. He had a cold recently which would normally have meant at least a trip to the GP but fortunately just needed a day or two with Ventolin... Looks to be under control for now 🙂