Expert: Bailey - 10/17/2006

Question
My son is 11yrs and suffers from allergies.  He also gets wheezy when he gets a cold that usually settles in his chest.  That's when the doc puts him on Sabutamol. At the moment he has no cold but his allergies are acting up for which he takes Nasonex.  He also has a very slight cough (like we clear our throat).  He does this 2 to 3 times per half hour.  Is this asthma flare up?  Should he be on meds regularly?  His peak flow is fine and even when he has a cold drops to about 80%.  One more thing, when he does wheeze (during a cold), it is only audible by putting your ear on his chest, otherwise not.  I just don't know how mild or severe his asthma or allergy is and when it is only allergy and when it is asthma?  Yes, I am confused.

Answer
Shemin,
 Has he been diagnosed with asthma? Asthma can be a very tricky thing, especially when allergies are involved. They often go hand in hand. Symptoms of asthma generally include a cough, wheezing, chest tightness, and trouble breathing. Symptoms of allergies are very similar so it's hard to say if it is an asthma flare up or an allergy. I would recommend having your doctor write you a prescription to get a peak flow meter. This way he can check his lung function regularly to help determine the seriousness of the problem. Lung function generally decreases during an asthma attack to below 80% but this is not fool-proof. Sabutamol is a short acting inhaler, which if he only has symptoms of asthma during colds is probably fine for a treatment. Problem with short acting inhalers in the treatment of asthma is that they temporarily fix the problem, but in the long run, they don't do much to decrease the chronic swelling in the airways. If your son has been diagnosed and he has frequent problems you might want to check with your doctor about placing him on a maintenance inhaler, which he would take everyday. Of course, if the problems are minor and not all the time and the treatment plan you have now works, then it's best to avoid going on medication on a regular basis. Wheezing can be loud enough to be heard across the roam or barely noticeable with a stethoscope. Not all asthmatics wheeze either.
A large portion of people who have asthma also have allergies. Allergies are a major cause of asthma so if your son has both, it can be very hard to distinguish between the two. Anytime he has difficulty breathing or is coughing excessively it should be evaluated by your doctor. It does not sound like from your letter that he has severe asthma, however asthma and allergies can rapidly get worse so it's important to pay attention to any changes in symptoms and discuss these with your doctor as soon as possible. Hope this helps.
-Bailey