My 8 year old suffers from what we think is cough variant asthma. Any viral infection (colds etc) just sets-off a horrible cascading coughing that just gets worse and worse over 3-4 days, until we need to give oral steroids. We often blast him with Ventolin (as much as 8-10 puffs every 4 hrs.... yes: a lot! But even this doesn't 'hold it'. Then we give his oral prednisone (20 mg x 3 days based on 1 mg/kg). We are based in Dublin, Ireland and see a consultant for respiratory in CUH.
He is also one Seretide 50 (2 puffs twice a day) monelkaust/singleair). Outside of a viral infection, he is totally and utterly fine - no cough, wheeze, lack of breathing.
My question is do any of you good people know of the impacts of 8 or so short courses of pred/oral steroids in a year... Horrible as it is to write this, that is where we are. Grateful for any information on this. I am very aware of the wealth of online information available about medium and long-term pred/oral steroids (weight gain, loss of bone density, adrenal suppression etc). Thankfully we've seen no signs of this (yet). We are very concerned about impacts to growth velocity - he's a small fella (but fine otherwise in terms of health - and very sporty).
I'd also love to hear if other parents and people out there had a similar situation and your eventual outcomes.
Thanks,
Olan
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Ollie1976
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In the nine months to June 2023 I had seven short courses of pred and one four week course. It is a little surprising when you add it up.
Since then I have been free of pred, though it is getting interesting at the moment.
There have been no obvious issues from the pred.
What I have been very lucky with, is my hospital asthma nurses who have been keen on trying me on a variety of drug combinations. I have also rang the asthma UK helpline a few times who have given me ideas to take to the medics. Is there an Irish equivalent?
All the changes they have tried me on have slowly helped, so my present drugs give me much more confidence than my drug combinations a year ago.
With a child I presume the available drugs are more limited, but I would encourage you to find out what a child can take for asthma and then talk to your medics and find out if they are worth a try.
Or do your medics need to refer your child elsewhere?
We are all different in what helps us.
Re the actual cold that triggers it, there are a number of people on this forum who are experienced at this, albeit it as adults.
One issue on the ventolin, my asthma plan tells me to call 999 if 10 doses are not effective.
Thanks for the reply. We are indeed trying combinations of meds (Seretide and Singleair being the latest) but these do not sufficiently reduce inflammation when a virus hits my son and then triggers the cough...
As for Ventolin: we can go beyond that would be considered a safe dose as his vitals are always fine (O2 etc). It's just this cascading cough which eventually stops him sleeping etc.
Hiya. Do u have an asthma plan?Also do u have an asthma nurse at gp practise.its gd to raise yr concerns with them.
My 5yr old grandson has asthma. Colds,viruses,bacterial infections,cold weather,camping - have all caused asthma to flare up.he goes straight up to 6puffs 4 x day + as needed,according to his asthma plan.usually,whn he's actually ill, it's been a chest,tonsillitis,ear infection + has required antibiotics.
Personally,If his peak flows dropped+ u
Think he may need steroids,I'd get him checked st drs x
Thanks for the reply - the issue is that his asthma plan isn't working. There is zero impact to PF - its just the cough. The Seretide and montelkaust/singleair + (excessive...) Ventolin should 'hold' the coughing during a viral trigger but its now not around 50% of the time. Note when I say cough, he's coughing 4-6 times a minute after 3 days and then it becomes non-stop. Despite this, zero wheezing of shortness of breath (well some due to coughing but zero narrowing of the airways).
Does sound like a viral cough .have u tried the children's linctus and lozenges to coat his throat? Or if he likes clear honey,it's great for coating throat and easing cough
my 12 yr old grandson has had various forms of steroids since a toddler for asthma which he’s now nearly grown out of. He’s now shorter than average for his age but within normal parameters. He’s perfectly formed and a top junior athlete .. playing at county level . May I remind you to persevere with the advice given on reducing steroid side effects by rinsing mouth/ teeth cleaning etc following inhalers . Best wishes … proud grandma x
Thanks for this - good to read that! I do think he will improve as he ages (he's turning 8 next week) and is small for his age (but mum and dad are also small - so mostly genetics there). Ironically he's super at sport and super-active (15-20,000 steps per day on his Fitbit!).
I do see from these forums that many people have it much worse with asthma and on long-term doses of pred. So my concerns do pane when compared to people on it permanently.
I hated taking Prednisolone as a kid, so much so, that I would hide them. Any cold or other virus would see my asthma symptoms flare. My mum dosed me up with Delrosa rosehip syrup, in the hope that would keep me virus free.
We know alot more now, such as, good dental practice will combat the steroid side effects on teeth, the use of a toothpaste with sufficient fluoride and a thorough rinsing after inhaler use. Your dentist should give advice on the best toothpaste and you may be able to get it on prescription.
As for bone health, exercise and a diet rich in vitamin D and calcium is ideal. Vitamin D is also important for our immune system. There was a sudden interest in Vitamin D levels during the covid pandemic and much written about its importance. Without vitamin D our bodies can't absorb the dietary calcium, which strengthens the bones and teeth.
Excellent reply from poobah on thorough rinsing & gargling after using inhalers, it helps prevent absorption through the sift tissues of mouth (for this reason I also rinse & gargle before as well as after). Your post reminded me so much of my son's childhood, it was so hard to witness his struggles, particularly in winter. I was told he might grow out of it by 7 or 14, he didn't at 7 but at 13 it eased then just about disappeared by 14 so he was able to fully participate in rugby tennis etc without inhalers. The medical support wasn't nearly so good then .
Personally I would give extra vitamins D3 and C - kiwis have more vitamin c than oranges I read somewhere.
Does your son take ventolin before exercise & sports? My g'daughter does, hides a ventolin in her sports bag (school strict about locking 'drugs' in form teacher's room, she's not always there & it's far from changing rooms). She's lots better now at almost 13, daughter ensures she has healthy diet, daily vits & kiwi/citrus.
oooo just remembered, I took my son at about 8/9 to Alexander Technique lessons, really helped him to open his chest, posture & breathing and he still uses it today in his 40s. He's lived in S of France for 20 years so rarely has exacerbations of asthma, only with a cold which usually turns into a cough.
Another thought, do you know your son's triggers? As adults with asthma we usually know and protect ourselves from our known triggers ie exercise, cold air or sudden changes of temperature, allergies & seasonal allergies. It wasn't until my own recurrence of asthma in my fifties after many months of constant infections, pneumonia & countless courses of antibiotics that I was referred to a consultant for a CT scan, lung function tests and allergy testing (aspergillosis or bronchiectasis was suspected on top of asthma). Allergy tests showed a mild reaction to aspergillus (fungal spores found in rotting matter ie leaves, composts, farms all of which asthmatic children should avoid) and a fierce reaction to mould. The other tests: pets, feathers, dust mite & some others i can't remember were fine - a huge relief that the Labrador could stay and I could get out my banned goosedown pillows/duvet and cease maniacally damp dusting/vacuuming the bed/bedroom/mattress.
Another import thing to consider is that the steroids are keeping son's airways open therefore helping to prevent infections and any resulting lung damage. Lung damage stays whereas with steroid use we can minimise the effects with the rinse & gargle, plenty of vits/calcium from healthy diet for muscles and bone development.
No need to shut-up: all advice most welcome and reassuring!
I'll definitely start vit supplements to maxamize muscle and bone development to counter-act (as much as possible) the side-effects of the oral steroids.
He is only turning 8 and I do expect that in 4-5 years he respiratory system will be much stronger and he'll fight more of these himself (as many posters have noted here already - which is reassuring). So for me (unless we find a magic solution), its a case of minimizing oral steroid use and supplementing diet with vits and minerals.
He is allergic to egg and dairy but fine for everything else.
My son was on various inhalers and Prednisolone when he was younger. He was noticeably shorter than his peers until around Year 10/aged 14/15 then he shot up and is now average height. He’s now 20.
Hi Ollie, we had a similar situation. 2-3yold 8-10 puffs every 4 hours, off the edge of a cliff when unwell. the weather was a huge trigger. We went down quite a few rabbit holes. steroids was the GP to to and never really worked but made her loopy, tried montilucas, 4 puffs a day of brown, and eventually, we worked out that antibiotics were the only thing that worked. (that and 4 x daily brown puffs and montilucas)
Not any antibiotics but broad-spectrum co-amoxiclav. other antibiotics worked for about a day. She was diagnosed with protracted bronchitis. Getting our GP's to prescribe this was a huge nightmare even with specialists writing to them, but they have finally got the message. she now has 4 months of antibiotics every winter.
My little girl has been on an adults dose of inhaled steroid since she was 2 and has had many short courses of prednisolone over her 8 years of life... she's short and I do think that's because of the prednisolone and inhaled steroids; but she can breathe and that's what matters
Your son’s story is certainly very worrying. That much oral corticosteroid can have side effects and if the diagnosis is correct, then he may need different treatment.
There are a few key questions I suggest you consider:
I) Is his cough caused by asthma? Ie is the diagnosis correct - has he got asthma, another condition or both asthma and something else?2) Is he being cared for by a paediatric respiratory / asthma specialist ? It would be helpful to find out- because if not, you should ,, as someone else suggested, be referred to one.
3) Is your consultant aware that your son is needing so many courses of oral steroids?
If he does have asthma, there are a number of things to consider:
Is he using his inhalers regularly and if so, is he using them correctly? Could he benefit from a different inhaled corticosteroid? If he does have asthma, and he is taking the Seretide twice a day and he is using the inhaler correctly his history suggests that it is severe and he may benefit from one of the so called biologic anti-asthma medications.
There is something else: how many Ventolin inhalers does he use in a year? Excess ventolin use ( more than three inhalers a year) is associated with problems which could be serious.
So in my view, your son should be seen urgently by your consultant if they are a respiratory/ asthma specialist. if your consultant is not a respiratory/ asthma specialist, then your son should be referred urgently to see one.
Thanks for the detailed reply. We are under a respiratory specialist indeed and frankly, he is confused my this - even saying he doesn't think this is asthma. All we know is that he totally fine until he get a upper respiratory virus and off we go with the cough... Even with the cough he is actually fine (i.e. no impact to his vital signs or breathing, until he's coughing non-stop).
The Ventolin does hold the cough initially but the cough ramps-up over a 3-4 day period until Ventolin doesn't work.... Then its a 3-day course of prednisone. Note around half the time he does not need steroids - he get through the episode just on Ventolin (much to our relief!).
Inhaler practice is good: we use a spacer, ensure the inhaler is shaken (to the meds are mixed with the propellant) and he takes 8 breaths between each puff.
Currently he is on the lowest dose of oral steroids (1 mg/kg so 20 mg per day x 3 days). Thankfully he is not on oral steroids in the medium or long-term - just for these episodes.
Re inhaler technique,as an inpatient at hospital,he was taught to keep breathing for 10 rattles of big spacer..consequently at home wld hurry it to 10 rattles.i taught him to breathe it in deep+ slow so it gets absorbed + has more effect
Hi Ollie 1976, this has only occurred to me this morning. Has your son had any tests to confirm he has asthma, I ask this because you say he is having high doses which are not working. 1 of the tests is a reversibility test using ventolin to improve a patient's peak flow.
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