Baby with “asthma”

[Agaths]

Hi, I just want a bit of advice around my 11 month son. He has had 2 chest infections since November, 2 courses of steroids and has a blue inhaler. The whole period since November he has been very wheezey and had a cough. Our GP has given us a blue inhaler and calls it a viral wheeze (as too young to diagnose asthma) what is concerning however is that neither the steroids or the ventolin (4 times a day) has eased his wheeziness. Could it be something else? I’m uncertain how to proceed? Do I just accept his wheeze down to winter? I just feel concerned that he shouldn’t be breathing like this all the time and feel our GP isn’t listening to my concerns. TIA.

[Minushabens]

Hi & welcome

This unwillingness to call baby wheezing asthma is something we see more & more & personally, it annoys me. However, it's increasingly common to see a refusal to confirm a diagnosis (whilst issuing asthma medication) until they are anything up to 8 years old, so it's probably what you're dealing with from the docs anyway.

So, the first thing to really tell yourself is that at his age, his respiratory system is small & easily irritated with bugs & viruses he has yet to encounter (ie he won't have a strong immunity yet). However, if he is showing wheezing as a response then asthma needs to stay with you as an option. My gut feeling is that the GP might know there's a strong likelihood of asthma but is prevented from saying so by local rules. The treatment he has given him nonetheless is consistent with treating asthma.

In terms of being anything else, yes there are many things it could be, most of which are minor by & large. You'll only really work this out over time. It might be worth discussing a steroid inhaler rather than a course of steroids (prednisolone I'm guessing?) to see if he can build resistance. If the wheeze settles to a degree over time, that's a clue as well as to what is going on.

You also need to widen your thinking about triggers as well if medication isn't helping. The usual suspects are things like pets, damp, smoke, dust (& lots of others you can Google to check). If any of those are nearby, they might well be a bigger factor than the virus.

Getting to grips with asthmatic children, should that ultimately be the issue, can be hard work, but trust me there's no reason whatsoever for him not to grow up fit, active & with a good quality of life.

I know that's a bit rambling, but I hope it's of some help.

[Agaths in reply to Minushabens]

Hi, thanks for your reply. I asked about a steroid inhaler but was told he is too young. I think the frustrating bit is that we don’t smoke, our house isn’t damp, it’s cleaned and mopped throughout once a week - we have a cleaner so I know it’s all done and clean! However my dad has asthma to this day, and both me and my husband had asthma as children although now it’s dormant. I am not sure what to try next, so we keep going back to the GP and say it’s still an issue or is it something that we just keep going on with?! He’s our first baby so it’s really hard to know whether I’m being a hypochondriac or I should keep going back. What would your advice be?

[Minushabens in reply to Agaths]

I don't think you're being a hypochondriac. NICE guidance says the following for asthma or asthma-type symptoms in under 5s:

"Offer a SABA as reliever therapy to children under 5 with suspected asthma. This should be used for symptom relief alongside all maintenance therapy.

Consider an 8 week trial of a paediatric moderate dose of an ICS in children under 5 with:

-symptoms at presentation that clearly indicate the need for maintenance therapy (for example, asthma-related symptoms 3 times a week or more, or causing waking at night) or

-suspected asthma that is uncontrolled with a SABA alone.

After 8 weeks, stop ICS treatment and continue to monitor the child's symptoms"

The abbreviations mean:

SABA = blue reliever; ICS = brown preventer - inhaled corticosteroid

pathways.nice.org.uk/pathwa...

You might want to give Asthma UK nurses a ring. Ideally you don't want to fall out with your GP, but my personal view, based on hard experience, is that you can't & shouldn't just wait & see.

Like you, I have inter-generational issues with asthma. My dad also had serious asthma & died from lung problems, I've paid the price of poor childhood treatment, but my son took steroid inhalers from being 3 months old, with a GP who was adamant that the best way to stop a recurrence of those problems was to treat him from the off. He's now extremely fit & active at 23.

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Hi Agaths

Do give the Asthma UK nurse team a call, they can be reached on 0300 222 5800 (M-F, 9-5) and can provide support and advice on what to do next.

Hope that helps,

Dita