Expert: Marc Rubin, RPh Asthma Educator - 10/9/2008

Question
Please help me help him...We live 30 minutes north of Houston, Texas and I have a twelve year old son who was born pre mature and was ventilated for RDS. He also had repair surgery for his diaphragmatic hernia.

We live 30 minutes north of Houston Texas. He was sent home for the first year on an apnea monitor. It was suggested by the nurse practioner who ventilated him that he may have had BPD. He has been diagnosed with mild asthma several years ago and uses a nebulizer with albuterol when symptomatic. Recently in the last 3 years he has been taking Advair 150/50 then increased it 250/50 or Symbicort or Flovent or all variations on the above at different times. Claritin and Zrytec and prednisone all when symptomatic (of course one or the other on the decongestant too)...not to mention Antibiotics for the occasional "it went to long and now he has pneumonia".
He missed 24 days of school last year. He is frustrated and would like to breathe normally....not noisy and be able to eat and breathe. He has had his tonsils out and his adenoids out in 2nd grade. P.E.tubes three different times. He is a straight A honor student in 6th grade and he is beginning to get upset that his work performance will fall behind if he keeps missing school. He asked my Pediatrician at his last appointment for a "refund" since he had to see him 3 times in 3 weeks and it is still not better. I finally asked for a referral from my Pediatrician for a Pulmonologist this Monday. I know the pediatrician feels he can handle it but I am starting to feel less faithful in all this since it is progressing and not improving as my son gets older....Why is he not growing out of this???  Any suggestions are greatly appreciated.

Answer
Hi Patti,

It is apparent that your pediatrician may not up on the latest national asthma guidelines (NHLBI, Expert Panel #3, Nov 2007). In addition to the proper therapeutic approach, one point in ALL medical guidelines is to guide the general practitioner when they should refer the patient to a specialist. This is not about ego or pride, but what is the best medical interest of the patient. I would insist on a referral to an allergist. To find a board certified allergist locally, go to:

http://www.aaaai.org/physref/ , and double check with the practice if they take your insurance.

In addition, you may also want to check to see if the group has a pediatric allergy specialist. Although not essential, it would be helpful. Also, once the physician has the birth records, they will be in a better position to ascertain the outlook for your sons improvement. Generally, there is improvement in the later teens, but the physician would be in the best position to advise you.

An additional point to take here is patient education. There are numerous sites including  the one above, but I'd also go to http://www.aanma.org/breatherville.htm which provides asthma education for both you and your child.You son needs to be a partner with the physician in learning to take control of his asthma, so it does not control him. The allergist should work with your son to develop an "Asthma Action Plan" such as one here:

http://tinyurl.com/q5j2v


There is also a free computer game that provides materials for both the child and parents:

http://tinyurl.com/5h2j98

One final question comes to mind...does your sone complain of acid indigestion? GERD (gastro-esophageal reflux disorder) can trigger asthma attacks. Anxiety can increase this situation, and it is fairly easy to address with medication. Again, the specialist will go over all of this with you.

Let me know how this all works out.

Sincerely,

Marc