Expert: Marc Rubin, RPh Asthma Educator - 2/12/2011

Question
Sir, I am from India, belonging to a small city called Ranchi. I do not have pets. I am 30. I have asthama since birth, though my parents or my sister and brother are free from asthama. But my grandfather had acute asthama problem. I get fever, cold and cough with ever season change (4-5 times in a year).

My son, Vedansh, is 2yrs 7 months now. He gets ill - fever, cold, cough, and high breathing rate - with every season change. Though the doctor here says he has not developed asthama as of now, but unless taken proper care and frequent illness avoided, he might develop asthama later. Doc also says his frequent illness weakness the cells f his lungs which may develop into asthama later, and hence recommends BUDATE 200 INHALER for next 6 months, with 2 dose daily at morning and evening.

Sir, here I would have your view:
(i) Is this particular inhaler addictive?
(ii) Would Vedansh be able to recover fully from frequent illness?
(iii) Is it true that after 6 or 12 months, we can stop the inhaler dose and the same would not be required later?
(iv) Does Budate 200 inhaler has any short term or long term side-effects?
(v) Your independant view over this matter.

Answer
Hello Manish,
1) The inhaler is not addictive at all. It is the gold standard of treatment in a patient with persistent asthma. Persistent asthma is where it is necessary to use quick-reliever medication at least 2 times a week during the daytime, and or using the quick reliever more than twice a month overnight due to increased wheezing or coughing symptoms.

2) If he has a viral infection condition called RSV (Respiratory Syncytial Virus), this is usually outgrown at about 5-6 years of age. On the other hand, if these symptoms are due to allergies, then it would be asthma. Some kids outgrow it, but many do not. If, during a breathing flare-up, the physician runs a CBC blood test and checks for a specific white blood cell called an eosinophyl, and the blood level of that cell were high, then he most certainly would be likely to have this condition throughout his life.

3) Asthma often runs in cycles where the need for the more powerful drugs varies with the seasons.If the patients is stable for 2-3 months, you can step down therapy, but that does not mean forever. You re-evaluate every 2-3 months.

4) Side effects are usually hoarseness and thrush (white growth in back of throat) which are normally avoided by gargling and spitting out after each treatment, or in the case of a child, following the treatment with fluids. Skin rash on face from the steroid, if using nebulization with face mask. Prevention accomplished by washing face after each treatment. Long term side effects, which are dose related, include 1)a small change in total height (possible loss of 1 centimeter) which is counterbalanced by a similar effect seen when a patient is chronically ill, resulting in poor nutrition, also leading to diminished growth, but in malnutrition, the effect is against all organ systems, 2) Ahead in life(adulthood), increased risk of cataracts, which is dose related. Keep in mind, if the condition is mild, it may be possible to control the lung inflammation with a product called Singulair (montelukast), which is taken orally, at bedtime. It can be used from the age of 2 (in a granular form).

5) And finally, children do sometimes grow out of this, most often around the age of five. But given your personal history, I would be more inclined that his path will follow yours. There are some critical points to understand.
> Drug therapy today has evolved tremendously from even 15 years ago. Much more effective and safer. I don't think this direction will reverse, but only get better.
> Drug therapy is only one-half the solution. It is extremely important to identify specifically those things that your lungs react to. That knowledge allow you to correct issues that may be present in your home and work, as well as allow you to take preventative measures before going to a location where you know you and/or you son will be exposed to the triggers. All the drugs in the world won't help if you walk into a situation you knew severely affected you in the past, and you didn't pre-treat, or even better, avoided going to.
> You must be compliant with your therapy. It is important to have a therapy plan in place so, in the times of the year your symptoms are lower, you may cut back on your therapy, under your doctors guidance. And when approaching those periods where you know create problems, start a few weeks earlier in stepping up the therapy to avoid lung changes.
> A great tool for monitoring lung function is called a "Peak Flow Meter". It is a very inexpensive plastic device that you blow into to demonstrate the force of exhalation. Most people with asthma have a poor perception of how they are doing (including my wife), and this make you aware of that, and your treatment approach can be modified in accordance to how you are doing.
Finally, NEVER go anywhere without your quick reliever medication (same for your son). The greatest risk you take is leaving home without it. This is the greatest cause of death from an attack....nothing to treat with.

I appreciate your concern for your son, and all I can tell you is every day, both my wife and daughter are diligent about taking their asthma meds, and getting their annual flu shot.

I hope this helps you.

Sincerely,

Marc