overuse of asthma meds = COPD?!

We moved to the UK from America last year and my 8 year old just had his first asthma review here. He has viral induced asthma and was diagnosed when he was 3, so dealing with this is not new for us. I was stunned to have the nurse tell me that our approach to his care was wrong. He has always taken his maintenance meds only upon the first sign of cold/flu symptoms and then his rescue inhaler (or nebulizer meds) as needed. I have been told by his prior doctor that the big goal with medicating children with asthma is to medicate them enough so that they do not need to go on oral steroids, but not to overdo it as the more they can remain healthy without any medicine, the better. The theory being that the long term affects of oral steroids on children is concerning at best. We've done well with that approach and once we were past the initial first season, we've almost not needed to resort to oral steroids at all. Now our new carer is telling me that I'm using his rescue inhaler too much (basically anything more than 3 times in a week) and that such overuse can lead to COPD in his later years of life. Her approach would be to prescribe the oral meds much after a week of symptoms. (She also wants him on maintenance meds 365 days a year.) WHAT?! If this wasn't so completely opposite from our prior advise it wouldn't be so concerning. And I don't mean to be elitist, but his carer in the States was not only a doctor, but also a specialist in allergy and asthma care. Has anyone ever heard about this COPD link? I haven't been able to find anything online in my initial searches. I hate to completely ignore this woman, but I'm just not convinced she's right. On the other hand, I certainly don't want to be doing something that will affect my son's later years.

4 Replies

  • Hi, my son is 2 and was only just recently diagnosed, but we have been given the same information as you have by the UK nurse. We have to use the brown steroid preventer inhaler twice a day for the foreseeable future (as this helps to build up a resistance and work towards preventing attacks from occuring, so its really important not to miss any doses). We were told we should find that we rarely need to use the blue reliever inhaler, as the preventer should do just that and hopefully prevent any symptoms (hopefully). But, if we find that we are using the blue reliever inhaler quite often, then we need to review his overall meds, as it may mean the brown preventer inhaler is not doing its job properly.

    It does sound very opposite to the way you have managed it previously, but I have to admit the way it was explained to me did make sense, but as I said I am fairly new to all of this and trying to learn about it the best I can.

  • I think what the nurse has told you makes sense, if he has a daily preventer then there should be fewer occasions where he needs his reliever and less of a chance of him needing oral steroids. The general guideline for any age is 3x a week for a relieve is too much and they need to be reviewed. The idea is that everyone has the lowest amount of medication they can handle, but this is increased if there is a problem.

    It's very strange how there can be such a different approach between the two countries!

    Maybe ring the AUK nurses and talk to them about both ways? Then you can get advice and an explanation from someone who is trained, which might help you to decide what is best for your son.

  • Thank you for your responses. Between your responses and some additional research, I think I understand where the nurse's advice was coming from. However, I still think that what she said (which is that the medicine itself can lead to life-long problems) was wrong. I did find information about how uncontrolled asthma can lead to chronic problems which is probably why she is telling me to go year around with the maintenance. I think our U.S. doctor asked for and monitored a bit more specifically (how many episodes, the duration, etc.) and determined that he was well-controlled with the prior approach. I suppose it is in how you define ""controlled"". I am willing to step up his maintenance and see where that goes. However, I still think that avoiding the oral steroids should be the goal (short of bronchitis or pneumonia). She could have done a much better job at explaining the reasoning behind the approach. I got the feeling it was a ""one approach fits all"" prescription and she was simply not well-versed in the rational and therefore couldn't explain it well nor was she comfortable deviating from that approach. Hopefully, the year-around approach will keep this from becoming a real issue and I'm just worrying for nothing.

  • How very confusing to get such different advice.

    I seem to recall a study that came out 3 or so years ago that said *some* people do just as well with intermittent / exacerbation or seasonally driven use of steroid inhalers. I don't remember the details but I do remember it making waves because it upset the prevailing wisdom that preventers should be used everyday. Perhaps that study or snorher one like it was morivsting your child's allergist inthe states?

    If you felt your child's allergist knew him well and was tailoring his treatment plan to your child's specific circumstances, perhaps it would've a good idea to call or email him/her and see what he thinks (and why) about the advice you are being given by the asthma nurse.

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