Two questions please - anyone know the answer to the Beclazone question?

Hi

My hubby has had a cough for a couple of months and his chest xray is clear. His doctor has prescribed a nasal spray and a Beclazone 100 inhaler. I note the indication for the Beclazone is asthma and it is a preventer. DAvid has not been prescribed a reliever. Is that usual?

Secondly ( what a grotty family we are) my 15 month old grandson has been wheezy and chesty. Again his chest is clear - although he has had to have anitbiotics in the past. Now the little one has been prescribed salbutamol liquid, which is helping a lot. Does this mean that he has asthma, or could it be an allergy to something?

Thanks for all your help.

Kathyx

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Hi Kathy

Small children very commonly wheeze with viral infections but this doesn't mean they have asthma. Salbutamol is used for the same principle as with asthma - it opens up the airways. Salbutamol is usually given in the form of an inhaler but he syrup works in the same way although it was found to be less effective than inhalers, I didn't even think Salbutamol liquid was still around! I've been a paediatric respiratory nurse for 10 years and we stopped using it about 9 years ago. I have never since seen a child on it - what a blast from the past!

Sarah

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Hi Sarah

Thanks for replying. Logan saw a paediatrician a few weeks ago as he has a slight heart murmur. His mum had also noticed him wheezing when he was crawling. Anyway, after lots of tests, the paed said he thought the murmur was just there when Logan was 'under the weather', but that he could hear the wheeze, so he prescribed an inhaler for him. It was very late in the afternoon, the baby was cranky and his mum needed to catch the bus, or wait an hour, so she never got the inhaler dispensed. Then, when he was chesty last week, she took him to the local gp who said that he thought it might be tricky using the inhaler and a mask, so he thought it would be worth trying the syrup, although, as you also know, it is not as effective as the inhaler. However, it seems to be helping a lot and he is a lot chirpier than he was. Fingers crossed that he can get by with this until he is a little older.

Kathyx

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Sorry to bring this up again, but just wondered if it is usual to give Beclazone without any other inhaler.

Kathyx

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Hi Kathy,

I would say that it is unusual to be prescribed a preventer alone. If your GP suspects asthma and is following the British Thoracic Society guidelines, the first step would be to prescribe a reliever such as salbutamol. This would also act as a diagnostic test - improvement in symptoms or peak flow would suggest a diagnosis of asthma. Then if his symptoms were requiring the use of salbutamol several times a day, or the symptoms were not fully controlled, the treatment could be 'stepped up' to include a steroid inhaler such as beclomethasone.

I'm also a bit concerned that your GP has apparently prescribed an inhaler for your husband without discussing the potential diagnosis of asthma - you say that you 'note the indication... is for asthma' rather than that the GP suspects asthma. Did the GP not discuss the potential diagnoses and aims of treatment with your husband? It sounds like there has been a bit of a communication failure - is there another GP at the practice that your husband could see, who could review the appropriateness of the treatment and perhaps share a little more of their thought processes with your husband?

Hope this helps and you get on alright,

Em H

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Hi Emily

Thanks for your response. I was concerned about the way the inhaler had been given too. David has some allergies that bother him from time to time, so has had a nasal spray in the past. Having asthma myself, I knew that the way his medication was given was very different to how mine was.

When David saw the doctor last week, it was about his 4th appointment with a cough - he had had two or three lots of antibiotics and his chest was definitely clear, as he had an xray. Anyway, the GP said there could be several reasons for the cough, but to try the inhaler and nasal spray.

I am even more convinced it is asthma now, as it was frosty here this morning when he took the dog out and he came back coughing and spluttering. I know it is wrong, but I gave him one of my salbutamol inhalers to use, as I thought he was going to be sick. He used it (grudgingly as he does not like to use anything unless he is prescribed it) and the coughing stopped after a few minutes. I think you are right - he needs to speak with the GP again, or see someone different. By the way, David mentioned past chest problems to the GP and was given the flu injection, which is good.

Kathyx

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Hi Kathy,

I agree, it does sound suggestive. Do you have a peak flow meter? If not, you could ask your GP to prescribe one, or purchase one from your pharmacy. It might be an idea if your husband were to monitor his peak flow three times a day, and when he has symptoms, and then take the results along when he goes back to the doctor. It would speed things along a little, as I'm sure the doctor should be suggesting doing that anyway.

Let us know how he gets on

Em H

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Thanks Emily

I do have a peak flow meter so will get David to use it for a week or two. He is supposed to go back to GP in 6 weeks, but I think I will hurry him along ...

Kathyx