Expert: Bailey - 2/20/2007

Question
Hi, I have some questions, I have a 4 year old son with bad allergies and asthma he's had it since he was about 2 years old..the last couple months he has been on predisolne the last time he was on predisolne he didn't get all his doseages because he would dump it or throw it up it takes me 4 hours just to get him to take that he's been on it 3 times in the last 3 months, he's had asthma symtoms for the past 2 weeks  and he is taking albutoral every 4 hours. This morning I took him to the doctors office because I woke up and checked on him and his ribs were sunkin in really bad (he's a skinny boy too so I don't know if that normal in the morning or not), when I woke him up his peak flow was at 33%, All week his peak flows have been low in the morning, and a little better after his albutoral about 50 to 65% but It don't start really working until evening when his peak flow comes back up to okay numbers. I told the doctor all that and he just got put back on Sigular today he said he wanted to advoid the steriod, I'm so worried...that his asthma is getting really bad but..I hope the sigular helps. I'm very worried that I won't be able to tell when I should take him to the ER. Is there anything I should be doing differnt...or is there any key signs that I should take him to the ER. His asthma has been fine all summer..event though he is allergic to alot of out door things. I dont have any pets, or a wood stove. I do live in a newer trailer with carpeting through out. I want to take the carpet out but I dont think we will be able to do that anytime soon.  

Answer
Hi Diane,
 The fact that your son is taking albuterol that often and has a peak flow that low in the morning is concerning. A peak flow below 50% should be considered an emergency. With a 4 year old, this may not be very reliable, and his lung function could be a lot better or worse then what you think.
 
Sunken in ribs is another sign that he is having significant problems breathing.
 
Prednisone is a very potent steroid and should be avoided if possible in a young child. However, it generally has very good results if taken correctly and may be necessary if the asthma gets too much out of control.   
 
Singular can be really good with people with allergies and asthma. Keep in mind though these medications are not usually immediate and it may take a few weeks for there to be any improvement.

In the meantime, watch him closely for any sign that he is getting worse. If he is having trouble walking or talking, is pulling in his ribs while breathing, or turning pale or blue then head over to ER. If you're in doubt about whether or not to go, then I would recommend going. Young kids have a tendency to deteriorate quickly without much warning so if he appears to be struggling a lot, take him in.
 
It sounds like you are doing good things to eliminate problems with allergies. You also want to wash any bed sheets, pillows, or blankets frequently as these can be big problems for asthmatics. Just watch him closely, and hopefully the singular will kick in soon. If not, there are many more types of medications so you may have to try a couple to find one that works out.
-Bailey