Expert: Marc Rubin, RPh Asthma Educator - 8/15/2011

Question
Hi Marc.  We have a 4 year old son with asthma who has had pneumonia at least 2x since February, and I think he has it again now.  In February, he had the flu, pneumonia in both lungs, RSV, exacerbated asthma,and a double ear infection all at the same time and was hospitalized in pretty bad condition.  In June, he had pneumonia again, and has exactly the same thing again now (I will take him to the Dr. in the morning.)  We live just outside a small city in a farming community (there is a large farm only 2 houses away from us).  We have a small dog, a hamster, and a guinea pig.  Our son is on Xopenex q 4-6 hrs. as needed and Pulmicort bid, both via nebulizer.  His pediatrician recommends that he stay on these meds for 2 weeks after finishing an antibiotic, and constantly on them November through March.  He doesn't seem to have classic "asthma attacks" except when he is sick (mostly occurring during the night when they do happen).   Most concerning to us is that it seems that every cold or runny nose goes straight to his lungs.  I hate putting him on steroids (pred for 10 days) and antibiotics so often.  Is there something we could be giving him or doing for him to strengthen his lungs and immune system, or would it benefit him to see an allergist or pulminologist?  It seems he is so wiped out that he gets sick every time he's around other kids, even in the summer. Thank you for your time, insight, and for volunteering on this site.

Answer
Hi Julie,

I would have him evaluated by a pediatric allergist to clarify if he does have asthma in addition to RSV. Kids generally grow out of RSV by 5 or 6, whereas asthma will continue.

I understand you hating the oral steroids, but it is imperative to get the lung inflammation under complete control. He sounds like a well informed doc in how he is handling this, but in difficult cases, you always want an experts full evaluation.

Farming community is a tough place to be with asthma. Dust, pollens, all the animal dander, and, we are entering ragweed season. I've given presentations in farming communities, and you have to gain even greater knowledge to deal with the challenges. In one town, the football field for the high school was surrounded on 3 sides by corn fields. They'd have 2 ambulances at every game as a preventative measure, especially since the nearest hospital is 30 minutes away.

I'm hoping the hamster and guinea pig are kept outside, and that the dog is kept from the bedroom. You want the bedroom kept as dander-free as possible, since it can aggravate the lungs to a significant effect while he is sleeping. We have a baby gate on our bedroom door for this reason (my wife has asthma). If they do reside in the bedroom, let me know and I'll give you further direction to resolve the problem, besides just removing the pets.

Any smokers in the house?  

To find a board certified allergist, go to

http://aaaai.execinc.com/find-an-allergist/

If you do get a clarification regarding the presence of asthma, I'll provide you with a number of learning resources for your son and your entire family. IT needs to be a team effort.

Look forward to hearing back from you.

Sincerely,

Marc