Expert: Marc Rubin, RPh Asthma Educator - 2/23/2011

Question
My son Wyatt is 2 years old. He is continuously having upper respiratory infections and bronchitis. I recently took him to the doctor because he was sick yet again with a severly congested cough and shortness of breath. The doctor didn't prescribe anything for him. Later that night I had to rush him to the ER because he was having a hard time breathing. They did xrays, blood tests for RSV, a flu test, and they came back negative for fluid build up or RSV and flu. The doctor almost admitted him because they couldn't find a reason for his sudden lapse because the day before he was perfectly fine. To end the night they gave him a breathing treatment which seemed to help him relax and catch his breath. The ER dr. also prescribed a Z-pack for the bronchitis he was diagnosed with. We live in an apartment with no pets. We keep the house fairly clean to keep from him getting sick so often. He has a rescue albuterol inhaler PRN and a nightly Singular. My question is; Are there tests I can recommend to the family dr to find out if he has asthma? My father and my brother both have asthma so it runs in my family. I just worry about when it is gonna be so bad I can't act fast enough. Thank you for your time.

Answer
Hi Misti,

Get a referral to a pediatric allergy specialist. They have access to the equipment to do a spirometry test in very small children.  Also, I'd ask your doctor if blood tests done during this attack included a CBC with differential. If it was done, and the eosinophil level was elevated, this is an indication of allergies.  This and viruses are the most common triggers of asthma attacks in children. Also, another test that can be run is an eNO, exhaled nitrous oxide. This is a good marker for lung inflammation. Finally, in working up a patient for an asthma assessment, family history is a strong marker.

Finally, while Singulair is a good add-on for asthma treatment, and does help some patients as a solo treatment, it doesn't help everyone. This may be the case with your son. If your doctor agrees that asthma is a likely diagnosis, the "Gold Standard" of controller therapy in asthma is inhaled corticosteroid (ICS). In a child his age, it would be nebulized budesonide (Pulmicort is the brand, but is available generically). A nebulizer is a cup into which the medication is filled, then, the cup is hooked up to a compressor. A mask goes on the nebulizer cup, and the resulting mist is inhaled. Treatments take about 5 minutes and are done twice a day. It takes a few weeks to get the lung inflammation down, and achieve better control. Side effects are low, and easy to control. In addition, the nebulizer delivery system is the best way to treat an attack with the albuterol in a child.

Let me know how things go.

Sincerely,

Marc