Expert: Marc Rubin, RPh Asthma Educator - 9/25/2009

Question
Your question was

i have a patient of 2 years old who has repeatative attack of asthma or bronchitics or pneumonia and i have to admitt him  about every 2 month, i have given him a following treatment
inj cefpodoxime
inj amoxycillin with clavatunate potassium
inj vancomycin
inj turbutaline
nebulization with levosalbutamol and budesonide formetorol fumarate
syrup dexomorphen and chlorophenemine and menthol
what should i do for prevent this repeatative attack

Answer
Hi Naresh,

Sorry for getting back so late. I was attending a COPD conference.

First, on what basis was the diagnosis made? Has he been screened for cystic fibrosis? Chronic airway infection is seen in this multi-systemic disease. As of the beginning of this year, all newborns are screened at birth.

Second, what is the determinant for antibiotic therapy? The two primary bacterial triggers are chlamydial pneumonia and mycoplasmic pneumonia, both treated with a macrolide antibiotic. Moth other organisms do not increase pulmonary inflammation. Of course, viral infections are always an issue.

Third, if the diagnosis of asthma is correct, dextromethorphan as a cough suppressant is of little or no value, and chlorpheniramine would further increase the viscosity of the mucous plugs. Increased fluid intake to insure hydration is very important.

Fourth, how does the blood work present? Was a CBC w/differential executed? In children, the predominant cause of asthma, as you know, is atopy, and I'd expect elevated eosinophils. Also, is it possible to get exhaled NO levels during exacerbations?

Fifth, what is the home environment like? Pets, mold, indoor household plants, good or poor housekeeping?

Sixth, how old is the nebulizer cup? There are two types, a short term disposable that is good for 2 weeks, and a long-term version, good for 6 months. If used beyond these parameters, the vent deteriorates resulting in a larger particle size mist that does not adequately enter the airways, resulting in treatment failure. It is also a good idea to have the compressor filter checked for cleanliness, and verify that the cups and tubing are cleaned properly.

Has the child been given any courses of oral steroids up to this point, and if so, how many times in the last 12 months?


My greatest concern initially is the differential diagnosis to insure we are not overlooking anything.

I will be awaiting your reply.

Sincerely,


Marc