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Pediatrics/Treatment for Ashtma for my kid (5 years old)

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Question
Hello doctor,

We are in India for last 2 years.
My Kid has been suffering from ashtma (Wheezing problem) intermittently in last 3 years. At the age of 2 years, She was admitted in hospital for 3 days with nebulization and problem re-occured atleast once in next subsequent 2 years. On all occassion, she had terrible breathing problems. She has been advised with sterorids after Ashtalin and been asked to continue with Levolin on frequent basis(Hourly for a week and after 6 days) and budecort then every day morning and evening.
I presume use of steroids and inhaler got some side-effects at both short and long run. She's been already complaining about leg pain and stomach pain.Not sure, if I got to continue with the same method (or) if it got some alternatives for treatment of Ashtma. Also, is getting cold and air pollution the only cause of Ashtma.

Answer
Dear Ram,

My sincere sympathies to you and your family ... indeed, asthma incidence has been rising globally, and doctors and care-takers are having to face the brunt of keeping their wards/patients free from the ill-effects of this chronic inflammatory disorder.

Inhaled steroids are an absolute must if your son is to outgrow his asthma. Hence, you should continue to give them to him for a long time. Usually, depending on the severity of his asthma, doctors would recommend continuous use for between 2 months to well over 2 years ... without a break.

Side effects of steroids taken by mouth or by injection are pretty big; however, inhaled steroids are, by and large, safe to use if one aims to use them at the lowest EFFECTIVE dose. For your 5-year old, a dose of about 200 micrograms of Budesonide in the morning (i.e. 2 puffs of a 100 microgram/puff inhaler) and a similar dose in the evening should be effective. Once she is free of acute attacks, you may try to reduce the night dose to 100 micrograms (i.e. 1 puff instead of 2), and then, after a few more symptom-free months, to stopping the night time dose.

Remember to use the Levolin puffs only when she has acute symptoms. At those times, levolin can be used as frequently as desired, even up to 8 puffs in a day. When you are giving her levolin, do not stop the budecort puffs. When both are to be used, first give the Levolin, then the /budecort puff.

Hope this helps.

Dr. Taher

Pediatrics

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Dr. Taher Kagalwala

Expertise

I come from India, and have been practising since 29 years. I am specially interested in infections, asthma, newborn care and parenting. I have authored a book on Parenting.It is called "Child Care: From Birth to Eighteen". The e-book is now available on http://pothi.com/pothi/book/ebook-dr-taher-y-kagalwala-child-care-birth-eighteen.
and on Amazon.com and all local versions, including www.amazon.in. I have my professional site at Blogger. Here, you can read good advice and also seek a professional online consultation for a small fee. Do check out http://drtaherforkids.blogspot.com.

Experience

Qualified Pediatrician practising since 29 years.
Currently working in the United Kingdom. You may reach me on my cell number +447440622670 or email me on drtaher@gmail.com only if I have not responded to your query here in a reasonable time. If you directly call me or email me, I might not be able to respond. Thank you for understanding. Please do not Whatsapp me.

Organizations
Indian Academy of Pediatrics, life member. Mumbai Branch of the I.A.P., life member. Genetics Chapter of the I.A.P.

Publications
Indian Pediatrics, Indian Journal of Pediatrics, Toxicology Abstracts.

Education/Credentials
M.D., M.R.C.P.C.H. (U.K.), Ph. D. (U.S.A.) D.C.H.

Awards and Honors
Gold Medallist in D.C.H., April, 1985
Highest aggregate marks in University of Mumbai, for M.D. ( Pediatrics ), October 1986.
Passed out with distinction from the Royal College of Paediatrics and Child Health, U.K. in 2015.

Past/Present Clients
1. Municipal Corporation of Greater Mumbai (K.E.M. Hospital) 2. Private consulting practice. Worked as the Asst. Paediatrician and DNB Teacher at Masina Hospital. Also visiting Saifee Hospital, Mumbai. 3. Ministry of Health in Kingdom of Saudi Arabia as a Specialist Paediatrician. 4. Now with the NHS, UK as a Specialist Paediatric Registrar at Blackpool, Lancashire, UK.

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