Asthma Update (cont.)
Member: My granddaughter is 15. This is her third case of pneumonia. Her asthma seems to be getting worse right now. She is on 60 mg ofprednisone and 4,000 mg of augmentin. Any suggestions?
Enright: Often pneumonia unless confirmed by abnormal chest X-ray in one with asthma is just a severe asthma attack. Very rarely an aspergillis infection can cause pneumonia and asthma that is difficult to control. Ask your granddaughter's doctor if the pneumonia was confirmed as viral, bacterial, or fungal. I highly recommend learning more about asthma from a book such as Dr. Tom Plaut's Asthma Guide or Jonathan Brostoff's book, Asthma. Then you can become a partner with your granddaughter's pediatrician in improving her asthma control.
Member: My 2-year-old granddaughter has asthma. She had RSV when she was six months old and her doctor says that some infants develop asthma after a severe bout of RSV. My question is this: She takes Singulair and has breathing treatments when it is at its worst. Since beginning the asthma medications and the breathing treatments she has nightmares and does not sleep well.
She was at the doctor's office last week for a bad spell with the asthma and chest congestion and was given a liquid steroid to take. She slept with me last night and I was awakened by her 13 times. I had to get up out of the bed with her once to quiet her. She was talking and crying about her toys. She never sleeps a full night and hardly ever sleeps longer that one hour without a restless period and crying out. Could this be a result of her medication, and if so will she outgrow it? She attends preschool and they say she is one of the brightest children in the class. I am worried that when she gets of regular school age the restless nights could play havoc with her school days. After one of her most restless nights this week the preschool teacher said she fell asleep while eating her lunch and slept for three hours.
Enright: Indeed it is unfortunately common for a severe respiratory viral infection to leave children and adults with asthma for the rest of their lives. Sometimes, however, this viral-induced asthma will only last a few months. The nightmares could be a side effect of the Singulair. Ask the pediatrician to confirm this. Her asthma seems severe at this point, requiring the use of oral corticosteroid (Prelone). Ask her pediatrician if daily use of Pulmicort in a nebulizer might be a better choice to reduce her airway inflammation.
Unfortunately, severe asthma is worse at night, and causes daytime sleepiness both in children and their parents.
Member: My son has reactive airways disease. He is now 5 and his flare-ups are few and far between, but he had one this weekend and had to use a nebulizer. Does this mean he'll continue to have problems or should he grow out of it?
Enright: It sounds like your son has mild intermittent asthma, which is often labeled by pediatricians as reactive airways disease. If he requires albuterol rescue inhaler more than twice per week ask his pediatrician for an asthma controller medication. About one-third of young boys do indeed grow out of their asthma by the time they become teenagers.
Member: What is the significance of oxygen saturation during an asthma attack? My O2 stats rarely drop below 94% even when I am barely moving any air, but my respiratory rate will increase to 30-45 for hours at a time.
Enright: You must have very severe asthma for oxygen saturation as measured by a pulse oximeter on your finger to fall below 93%. Lung-function measurements such as FEV1 are much more sensitive than pulse oximetry to detect bronchospasm exacerbations.
Member: Have there been any studies on the difference in peak flow/FEV1 drop in cough variant and typical asthmatics, and its relationship to acute severity? If so, what have they shown?
Enright: Cough variant asthma is asthma without wheezing. It is poorly understood by physicians and very little research has been done on patients with cough variant asthma. It usually responds to conventional asthma therapy. Some patients with this disease also have decreases in lung function, but others do not.
Member: What hope is there on the horizon for those of us with more of an intrinsic rather than extrinsic asthma?
Enright: The terms intrinsic versus extrinsic asthma are rarely used anymore. There is very little differences in the way allergic versus non-allergic asthma are treated. If the new anti-IgE medication ever becomes approved for use in the U.S. it is more likely to help those with allergic asthma who have high blood IgE levels.
Member: Am I going to have stay the rest of my life on medication to control asthma? I've had it for five years and I am 34 now.
Enright: Unfortunately most people whose asthma started in adulthood continue to have asthma for the rest of their lives. You have an opportunity to reduce your need for daily medication by identifying triggers such as GERD (heartburn), or sinusitis, or indoor allergens at home or in your workplace.
Member: Should everyone with asthma have an action plan and peak flow meter? I have moderate persistent asthma and my doctor (wonderful man) said to just "pay attention" to my breathing and I should be fine.
Enright: Everyone with asthma should have a written asthma action plan from his or her physician. If your doctor has not given you one, download one from the site on WebMD and take it to your doctor at your next visit. Some, but not all patients with asthma find that objective measurement of their lung function using a peak flow meter or portable spirometer helps them to manage their asthma better than simply relying on symptoms. Dr. Tom Plout's Asthma Guide has several chapters that describe how to use peak flow meters for optimal management of your asthma.
Moderator: Dr. Enright, we are almost out of time. Do you have any final comments for us today?