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Unhappy with asthma specialist

Hi, my now 9 yr old daughter was having some trouble breathing, and said she felt like she was being stabbed with pins in the chest. I took her to the doctor, obviously, and was told he wanted to check her out for asthma, so he sent me to the practice asthma specialist, for a spirometry test.

We waited 6 weeks for the appointment, only for her to decide not to do the spirometry test, and instead she did a single peak flow test. She ""scored"" a 240, which is higher than the predicted score of 233 for her age and height etc. The specialist then declared, ""There's absolutely no sign of asthma, so we'll send you home with a peak flow meter and I'll organise a prescription for an inhaler.""

I was a quite shocked she would do this even though there was no sign of asthma. I asked, ""If it's not asthma, how do we go about looking into what else it could be?"" She said to go home and take the peak flow readings several times a day for two weeks, and to take the inhaler minimum 4 times a day for a month, then go back and see her. If it's not asthma, she will then refer me back to the doctor, who might want to refer us to a paediatrician.

I feel she's just made up her mind that it is asthma, despite there being no sign of it, and I'm upset that we waited 6 weeks for a peak flow meter reading to be taken. Why did we not get the spirometry test that the doc wanted done?

I'm also concerned that my daughter has been given medicine she most likely does not need. Is it dangerous to allow her to take the inhaler if no asthma is present?

And what if the actual problem gets worse in the meantime? My daughter goes very pale and gets dizzy during these ""episodes"" where she says breathing hurts - it's not that she can't breathe, it just hurts to do so, sharp pains, like she's being stabbed with lots of tiny little pins, she says. I'm concerend about it maybe being a heart issue, but how do I convince a doctor to look into that when it feels like they've made up their mind that asthma is the problem, despite the peak flow showing no evidence?

My daughter has just had an ""episode"" after running up and down the stairs, right now, so she has done her peak flow meter reading while I'm typing this out, and got a 260. Surely if it was asthma induced the reading would go down?

Can anyone advise me on any aspect of this? I' know I've got a lot of questions, and intend to head back to the doctor, but this week is hectic - I need to know if I need to cancel our plans and get her to the doc asap, or if it can wait 'til next week. I'm very anxious and concerned for her.

1 Reply

It is silly to do a single peak flow reading and then make any decisions about an asthma diagnosis. A one off peak flow reading tells us almost nothing. Peak flows are useful when used over a period of time, and are considered as a % of personal pest, NOT predicted. My personal best is 600, so I am struggling anywhere below 450, and in trouble below 300. Spirometry isn't even that acurate, but a proper spiro with reversibility is much better. I suspect the doctor didnt order the sprio correctly, it sounds like a resp refferal, and then the resp cons would have to order the spiro seperately if they decide it is needed. A good recording of peak flows over time esp when symptomatic or not (and first thing in the morning can be a low point, and early afternoon a high point). It's even more odd that she's been given asthma medicaiton without any evidence of asthma (apparently)! Which inhaler? Most are relatively harmless, used for short periods and under the guidance of a specialist so I wouldn't be hugely conerned in the short term about her using them.

I dont know what it might be. Pins and needles type sensations can be common in panic attacks (to do with low co2 i believe), but also you can get pins and needles with nerve problems, I have never heard of it being a cardiac symptom but it may well be. Is her breathing completely 'easy' and can she take a full breath, its just unpleasant to do so, or is the pain so intense its impossible to take a full breath? How often do the episodes occur? are they only after exercise, or can they happen at rest? Randomly or triggered by anything? Is there any family history of anything? I can't make a diagnosis but those are the kinds of things to discuss with her doctor. Maybe a symptom diary (along with peak flows and anything that makes it worse or better) might be helpful to take along! Book a double appt to explain your concerns. I am not a doctor but to me personally I have never heard of that as an asthma symptom, and kind of find it hard to believe that a respiratory condition would cause those sensations - but maybe its just a rare symptom, or a condition I dont know. Lungs, as far as I recall, dont have nerve endings, which means any'lung pain' is likely to be reffered from elsewhere.

when you see her in a month it'll be a good time to raise these concerns. If she's really struggling then go to hospital, there is no hard and fast rule as to when to go, but mums instincts tend to be pretty good! Some mayor respiratory things to watch for are blue tints to lips or fingernails, unable to talk in sentences, intercostal recessions or tracheal tug (i believe there are good videos of this on youtube) but its basically a sign kids are working hard to breathe. Then any symptoms that are severly affecting her ability to breathe, any palpitations etc are all gonna be red flag signs Its very difficult to have a clear idea of whnen to go in when there isnt a confirmed diagnosis!

wish I could be of more help!

hope things are better soon!


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