Symptom changes advice please

Hi I have got a couple of questions. My daughter who is 9 has had asthma since she was 18 mths and her main symptom has always been a cough. She has never wheezed (except when she also had a chest infection). Over time I have learnt to recognise when she gets bad as she always says she is fine (!) until she can't speak. However this week she has really thrown me! She has not had a cold just a sore throat and earache, her peak flow was ok just about 50 under her normal but she said she had a tight chest ( a first) she had no cough and no night-time symptoms. She seemed quite breathless so to be on the safe side we went to the GP and ended up on pred. This hasn't worked too well and she is still on 4 hourly ventolin so we are back to the GP tomorrow. I guess I would like to know if anyone has had a similar experience. I must admit I am concerned that this time there was no symptoms that anyone could pick up (the school etc) I have tried to impress on her how important it is to say if she is unwell but she is only 9! Any advice/experience would be appreciated. (Have also posted separately about my son)

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Hi i to very rarley wheeze just cough but more recently when starting to struggle more get tight chested and struggle to breathe and talk likewise tend to end up on pred which doesn't do a lot and still need ventolin regularly on the top. Think the one thing i also do is say am fine until can cope no more as otherwise people tend to fuss and i feel that i can't cope if not feeling 100%. It's a case of finding a happy medium so your daughter recognises when she needs help as i have found sometimes that ventolin helps and can carry on while other times i have to admit that need more help. Sometimes a longer course of steroids is actually needed to actually sort symptoms out. what meds is your daughter on? if she is not on a long lasting inhaler it may be worth asking. Good luck at gps and let us know how you get on.

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Hello, I am sorry to hear that your daughter is not improving as quickly as hoped, when my son was younger he had a similar development, what eventually resolved the problem was a change of rotahalers / preventers. Longer acting medicines. Also she may need a longer dosage of steroids and maybe even antibiotics as she may have a throat/ear infection. Do not dispair, all I can say is that my son is now a healthy 6'6"" that needs a little puff of his ventalin very rarely.

Good luck. Susy

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Hello. Thank you for your replies. Sophie is on Flixotide, Serevent, Singulair and then Ventolin, Beconase and anti-histamines as needed. We went back to the GP on Friday as her PF had still not picked up and she was still tight- chested and needing lots of ventolin. She has been given 2 more days of pred and I was told to try and cut down the amount of ventolin she was having (4/6 puffs every 4 hours) as she was ""getting dependant on it"" what does this mean??? She is obviously needing it as becomes quiet and sits down, she only asks for her puffer when she really really needs it and will say NO if I ask if she needs it and she feels she doesn't so I am a bit worried about just not giving it to her. Could she feel dependant on it?? (I don't have asthma) Thanks again for positive replies!

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am puzzled why she is on both flixotide and beconase as i thought that they were both steroid inhalers. Perhaps someone with more knowledge could put me in the knowledge here. I take my antihistimine all year round cause taking it on as and when baasis means symptoms got hold b4 meds have

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beconase is nasal spray meant to deliver steriod to the nasal passages, flixotide is meant to do the same for the airways - lungwise.

Bex

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Hiya, As your daughter is on a fair bit of medication i would ask for a referal to the hospital. My son has seen a GP only a handful of times for his brittle asthma as he has open access at the hospital. And in my limited experience of them, they don't know enough about the condition....,Please don't anyone shoot me down about this, but they are, as their title suggests, General practicioners. If your daughter is not improving she may need a longer course of steroids or some other drugs added as a tempory messure. (i'm no doctor though!) I have heard that people's asthma can change as they get older, my son's has gotten worse.

I would ask for a complete review and an appoitment with a consutlant at your local hospital. I hope she gets better soon! x

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Hi Tina,

I'm sorry to hear that your daughter is still struggling, I hope the pred kicks in and helps her soon.

It is common, especially in children, for asthma to present in ways other than the conventional wheeze and breathlessness. Cough and tight-chestedness can be the predominant symptoms. It's also very common in children for them to have a relatively poor perception of their symptoms and to have difficulty in recognising and saying when they are deteriorating. You seem to be doing the right thing in learning to recognise the signs that things are not so well with her - these can vary from child to child, but you are right that sitting down and not talking are things to watch out for.

In terms of being 'dependent' on salbutamol - it certainly is not an addictive drug, so you don't need to worry about that. Many of us are 'dependent' on it in a sense, as we are on steroids and a lot of our other drugs, simply to be able to breath and maintain a reasonably normal quality of life. However, this is not really something that we can do anything about, and not something that should be framed in a negative way by your doctor. It is possible for people to become psychologically dependent on it, usually due to the fear of having an attack and being without it (which is a very reasonable fear, of course). Signs of psychological dependence usually involve excessive anxiety about not having your inhaler beside you at all times, and reaching for the inhaler at the first sign of any breathlessness. It doesn't really sound like this applies to your daughter - if she is only asking for it when she has become quiet and sat down, and obviously really needing it, and refusing it when she doesn't need it, it doesn't sound likely that she has undue psychological dependency.

Most general practioners are excellent at managing asthma - it is, after all, very common (brittle asthma, by contrast, is quite rare, affecting perhaps 1500 - 2000 people in this country, so many GPs will not be so experienced with this form). However, with the level of medication that your daughter is on, it wouldn't be unreasonable to ask for a referral to a hospital consultant. If she is uncontrolled on four agents (BTS step 4) that would usually be an indication for referral.

A hospital consultant can also look at the possibility of other conditions that may be contributing to your daughter's symptoms - for example, gastro-oesophageal reflux is quite common in young children, can present with no symptoms ('silent' reflux) and can be a significant factor in making asthma worse. Post-nasal drip can be another factor that can make asthma worse. You also mention that your daughter is on antihistamines and nasal steroids - has she had specific allergy testing done, and has avoidance of allergens helped at all?

There are lots of avenues that a hospital consultant could explore with both investigations and other potential treatments that might help. You have a right to a second opinion if you are not happy about the treatment your GP has suggested, or if you want to just make sure that your daughter is getting the best possible treatment, so do consider it.

Hope this helps

Em H

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Thanks Bex perhaps need to get eyes checked rather than chest actually read meds as becotide as oppose to beconase doh. teach me to read when awake as oppose to half asleep.

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Thank you so much for all your replies!! Sophie sees a consultant every 6 months and has done for the last 3 years after a particularly bad winter and 3 hospital stays (oxygen etc) in 10 weeks. On the whole she is very well controlled but does have episodes which are sometimes difficult to get under control. However this time after the additional pred she is much better. Her PF is still not back to normal but she is only having ventolin morning and evening. She says her chest still feels ""a bit"" tight but appears fine. I asked the GP about allergy testing but they seem really anti?? I have been told that they often don't pinpoint whats wrong and also that responses to allergens change as they get older so there is no point ??? (I don't know if that is true or not??) I have recently changed my GP and so far they seem brilliant , they have listened and I have not raised the subject of testing with them so that may well be an option. Thanks once again for all replies. Tina

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COUGHING, CHANGE OF SYMPTOMS, FUNNY HANDS, colourings and other things.....

Hello, I haven't been on this site for ages but my youngest, 5, had a very sudden asthma attack at school yesterday and it was unlike anything she ever had before, being seated quietly at her desk working on a poem when it happened.

Your email caught my attention because my both my children are asthmatic and both cough as symptoms. The elder one is 9 now.

Do you find people do not take the coughing seriously? Yesterday, for the first time since starting last September, my youngest suffered from asthma at school and it flared up so badly and quickly I received a call asking me to get there A.S.A.P. as they had called an ambulance - the ventolin was ineffective and she was in a right state - I could hear her in the background.

The reason I mention coughing is that two of the 4 paramedics made comments about her 'coughing', 'it didn't seem like asthma' etc etc and I felt like thumping them!!!!! I have this all the time. We have had a bad time this year with her asthma, previously beautifully under control, flaring up since June when we holidayed in Cornwall - where we go every year.

Yesterday we made a little progress in that the paramedic, seeing the ventolin I was giving using a spacer, was doing nothing offered a nebuliser and it was FANTASTIC! Another first for her but we now know it works well and quickly. It has never been offered before because she is 'just coughing' not wheezing or breathless. Childrens A&E were fantastic and gave another 'dose' of the nebuliser before discharging her with a lot of advice and a prescription for a 3 day course of steroid tablets. She has (fingers crossed) been fine since though pale and with dark rings under her eyes - the attack really has taken it out of her.

Of course it has scared the living daylights out of me which is why I turned to the forums. It is so reassuring to know other people go through it, often worse. I also phoned the nurse on the helpline as my GP surgery is very weak on asthma, indeed the whole area in which I live is, and they were a fantastic support.

I know no one else with asthma excepting an adult friend. One strange thing that happened to my daughter yesterday was before it all kicked off she said her hand felt funny, she couln't do her work, it kept going wrong. The Dr said this is a warning sign and is oxygen not getting around the body. My asthmatic adult friend also gets this. It may prove a useful warning sign should it happen again.

We have added complications in that there has been 1 confirmed case of measles in the school and both my children use steroids so we are really watching out for them, in fact youngest was sent for a blood test today after yesterdays attack. I am also expecting my 3rd child in 5 weeks and am stressed beyond belief at the moment at the prospect of measles (which also affected my 3 nephews 11, 18 months and 3 years) two of whom had the MMR. The girl at school, in my eldests class, also had the MMR and was very ill. Just my luck that she was sent home with it last week AND her sister is in my youngests class. The incubation period is approx. 2 weeks so I am dreading next week when any further cases could be discovered. I do not know what to worry about first!

With regard to triggers my youngest attended a party on Sunday where I left her for the last half an hour to take her sister to a dance exam. A friend brought her home again (though after yesterday I dare not ever leave her again) Her sister has an intolerance to artificial colourings and youngest does not usually eat them also. At parties we store up the sweets and go through them carefully at home, choosing from buffet food they are 'trained' to go for white icing, leave anything brightly coloured or they have never had beofre. However, in my absence, youngest was very honest and told me she ate a pink cake, a yellow cake (her sisters worse colour) and a green lollipop.

We think this was a possible trigger for such an unexpected and severe attack although her sister would react in 30 minutes not 24 hours by vomiting and then having bad asthma cough at night. I wonder if your daughter could have eaten something different or even come into contact with a substance such as air freshner or perfume, both no no's for my eldest! She reacted so violently to a Teaching Assistants perfume in her reception year they had to swap the staff around, though it caused rhinitus not asthma. To end on a positive note because we have had so many bad episodes since June I pushed for a referral at my GP surgery today and got it and we have a paediatric appointment for 2nd January. I really hope this will help us get to the bottom of the problem. I hope things are better for you now. I think I am correct in thinking you have 2 asthmatic children like me. It is such hard work and so exausting especially when they are taken bad at night. P.S. It was also recommended I change the spacer for a volumatic as the kind she was using was more for toddlers and the volumatic would help get more inhaler where it is needed. I shall need to do this for her sister too, who is 9 and stil using the toddler one! I told you my GP surgery was not very up on asthma!