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Asthma/18 month daughter with asthma

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Question
I have 18 month girl with respiratory viral infection and when she is awake she is better in herself playing and only a slight wheeze and crakle she is on 4 hr blue inhaler 10 puffs. Another consultant gave my daughter montelukast 4mg sachet a day for a year and she is also on clenil 100mg 1 puff morning and night .Her sat levels in day are about 96-98 which is good for asthmatics but at night they drop to 87-89 and stay at these figures. So she requires oxygen. A consultant today advised that this maybe her normal figure asleep and tried to discharge me even though her levels were not going above the 90's which I disagreed with as I don't have a sats machine at home and I wouldn't know if the sats drop to that level and don't have oxygen. She was born 2 weeks early in water pool with no complications. She did get bronchiolitis at 6 month old and were in hospital 15 nights as she kept needing oxygen at night .I have been in hospital for a week and I don't want to leave when she goes to sleep her levels drop below 90 O2 any help?

Answer
Good morning Paula,
   It sound that your child has RSV, Respiratory Syncytial Virus, the most common cause of bronchiolitis and pneumonia in children. There is a definite seasonal cycle to this virus, predominantly in the winter and spring of the climates you and I live in. As the child gets older, the attacks become less frequent, and often disappear when elementary school starts.  Daycare centers have been shown to have the highest level of attacks. Most commonly spread by coughing and sneezing, although coming into common surfaces with other infected individuals can also spread this virus. The need for hospitalization is about 1-2% of patients infected.
  I don't know what basis the therapy your child is on is being made. The meds your child is being treated with is not used for RSV. Has an evaluation been done by a pediatric pulmonologist or pediatric allergist? Do you know what blood work has been done...like an IgE level, eosinophil levels, allergy testing?
 In regards to your childs oxygen levels, a pulse oximeter, that a finger is inserted into, is an inexpensive device..about $35 american. I would think there would be one in a pediatric size. If you are able to obtain one, then work with the pulmonologist as to the decision process to bring your child to the hospital based upon symptoms and pulse oximeter readings..
 Note: if allergy has been verified, what are her triggers, and are you doing everything you can to remove/reduce exposure?

If you have further questions, or additional information, please get back to me.

Sincerely,

Marc

Asthma

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Marc Rubin, RPh Asthma Educator

Expertise

I have worked directly with patients as well as caregivers for over 30 years. Have made presentations throughout Illinois educating school nurses as well as the teaching and coaching staff of public schools about asthma, and how they should respond to these students needs. Presented a public education program on asthma through the US Department of Public Health. Specialize in helping guide asthmatic patients to take control of their disease in order to live a near-normal, fully active life.

Experience

Practicing pharmacist for 40 years, specializing in asthma and COPD for 12 years. Developed nationwide education to nurses, teachers and athletic coaches regarding asthma and exercise induced bronchospasm. In addition, and closer to home. my daughter has asthma, and my son has exercise induced bronchospasm. In addition, I serve on the boards and committees of a number of asthma organizations: Sports, Exercise and Fitness Committee of AAAAI, Population Health Committee and Sports Medicine Committee of ACAAI, Sports Medicine Committee of the World Allergy Association. Board of Directors of the Chicago Asthma Consortium, Board of Directors of the Christopher D. Redding Youth Asthma Foundation, as well as the advisory board of a medical education company, Emmi Solutions. Directly involved in the creation of public education programs for asthma, COPD and diabetes.

Organizations
American Academy of Allergy, Asthma and Immunology / Sports Medicine Committee, American College of Allergy, Asthma and Immunology / Population Health Committee and Sports Medicine, American College of Chest Physicians, American Thoracic Society. World Allergy Association, Chicago Asthma Consortium / Professional Development Committee, Christopher D. Redding Youth Asthma Foundation, and Respiratory Health Association of Metropolitan Chicago: Development Committee for AE-C prep class, and presenter.

Publications
AAAAI PowerPoint on the new guidelines for EIB (Exercise Induced Bronchospasm), AAAAI Powerpoint on Asthma in School Setting for Teachers and Coaches, Annals of Allergy, Asthma and Immunology: Transition guide for teens with food allergies or asthma going out of the home to live independantly.

Education/Credentials
BScPharm, RPh, (NAECB Certified asthma educator in 2002), NIPCO Certified Respiratory Care Pharmacist

Past/Present Clients
Emmi Solutions, Chicago Next Level Health, Chicago

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