Asthma Update (cont.)

Member: My daughter was recently diagnosed with asthma. After visiting the specialist she recommended a nebulizer. After two weeks of once-a-day use my daughter's appetite is almost non-existent. Is this a normal side effect?

Enright: It is important to know what type of medication is placed in the nebulizer. It could be a bronchodilator, which makes her nauseated. Inhaled corticosteroids increase one's appetite, on the other hand. Ask the doctor if Xopenex might cause your daughter fewer side effects.

Member: What advantages are nebulizers over just rescue inhalers?

Enright: Nebulizers are usually driven by a motor or battery powered unit, costing about $200. It takes more time to deliver asthma medications by nebulizer, but for children under age 2 who cannot easily use a traditional metered dose inhaler (MDI) a nebulizer is useful. Studies have shown that inhaling most asthma medications by nebulizer for adults is no more reliable than using inhalers, especially the new dry powder inhalers.

Member: What are the most obvious signs of asthma in a child? My son is 26 months old and I've been wondering if he may have a slight case due to constant coughing and congestion. He also breathes thru his mouth.

Enright: All three of those can be signs of asthma. You might purchase a $5 stethoscope from a pharmacy to listen for wheezing, but it's not always present during asthma attacks. The next time your child has such an episode, take him to an urgent care center for evaluation.

Member: Can you diagnose asthma in a child under the age of one?

Enright: Pediatricians are loath to make the diagnosis of asthma in children under age 3, because more than half of them "grow out" of it. The risk of lifelong asthma is higher in children with asthma symptoms if their family members have asthma or if they have high blood IgE levels.

Member: Hello. I have twin girls 7 years old that were six weeks premature. They have been diagnosed with asthma. About two years ago their doctor put them on Flovent. They take two puffs from an inhaler a day. Brittany's asthma is worse then Jennifer's. Jennifer has now acquired high blood pressure. My question is whether or not this condition could be related to the daily use of Flovent.

Enright: Good question. Corticosteroids such as prednisone when taken by mouth are known to increase blood pressure and make diabetes worse, amongst other long-term side effects. Manufacturers of inhaled corticosteroids such as Flovent do not believe that such serious side effects are occurring more than 5% of the time when they are used every day. However, there are reports of children taking high daily doses of Flovent who have experienced serious side effects such as hypertension.

A SIDE COMMENT: A young man asked about taking Primatene Mist for asthma. He likes to treat his own asthma without seeking medical attention or using prescription medication. I believe this is a dangerous approach since asthma can worsen suddenly and even cause death. Asthma medications available only by prescription are much safer than over-the-counter remedies and are much more effective. Primatene Mist is adrenaline, and when overused has caused death in individuals with heart disease.

Member: Is there much difference in Advair 100/50 and 250/50? I am on 250/50 but would love to try and go down a step

Enright: Advair comes in three strengths, all of which contain 50 micrograms of salmeterol (Serevent), a long-acting bronchodilator.

The three strengths of Advair vary in their dose of fluticasone (Flovent), either 100, 250, or 500 micrograms per inhalation. Advair has quickly become the most commonly prescribed medication for asthma in the U.S. Once a person's asthma has become controlled taking a higher dose of Advair, for three months or more, the patient should work with his or her physician to step down the dosage. Therefore, you are correct in wishing to move to a lower daily dose if you have been in the green zone of good asthma control.

Member: Do you think Pulmicort causes less systemic effects and adrenal suppression than Advair or Flovent?

Enright: For equal daily doses, I believe there is no difference in either the effectiveness or long-term side effects when comparing these two potent inhaled asthma medications.

Member: What is causing asthma in our children and what do we need to change?

Member: Why the huge increase in childhood asthma? Is it pollution?

Enright: There are many factors that cause asthma. Choosing the wrong parents is a major factor. Indoor air pollution with allergens such as cockroaches, house dust, mites, and pet dander are also important factors.

Some people believe in the (hygiene) hypothesis that states that asthma has become more common in the developed industrialized countries due to the overuse of antibiotics and excessive cleanliness. Outdoor air pollution is also a factor and worsens asthma control, but I don't believe it's a cause of asthma, except in some occupational settings.

I believe the most important thing you can do to control asthma without the use of medications, or to reduce your need for asthma medication, is to obtain allergen skin testing, and then work to reduce your exposure to indoor allergens to which you have become sensitized.

Member: What is the link between allergies and asthma? Does having one make you more likely to have the other?

Enright: Good question. Absolutely. Both children and adults with hay fever allergies (rhinosinusitis) are much more likely to develop asthma than compared to people without allergies.

Member: What is silent asthma?

Enright: I believe that silent asthma means asthma that does not cause wheezing. Some people have asthma that only causes cough or chest tightness. Also, people whose asthma is becoming worse over several days will stop wheezing when their asthma is life-threatening.

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