Asthma in Kids - Steroids Truly Necessary?

In My Humble Opinion
1

My 3-yr-old daughter was diagnosed with asthma earlier this month, during a hospital stay necessitated by RSV. Her doctor concluded that she’s asthmatic because (a) the RSV made her quite ill, (b) x-rays didn’t indicate anything else, and © she didn’t really start to improve until they put her on steroids.

I’d been wondering if she was asthmatic for a few months because she was coughing at night and had a series of respiratory infections. But I never heard a wheeze and neither did her doctors (until the RSV, then everyone with a stethoscope could hear it; I never did).

So now she’s home and A-OK (thank goodness), full of her usual energy. She’s on Singulair and is supposed to take Pulmicort (a steroid) via nebulizer, until the end of the “season”. We also have Albuterol on hand - at first she was taking it 4x/day, but wasn’t having any breathing problems so I backed it off and then stopped completely.

I don’t want to do the steroid.

I’ve taken steps to remove allergens in the home (beds in bags, cleaned filters, lotsa vacuuming). I also took the kids out of nursery school since they didn’t want to go anyway, we need to save some $$, and exposure to other little kids seems like a bad idea right now. I’ve quit taking them ANYWHERE for the time being.

I know that managing a child’s asthma can be a lengthy process. I’m not seeing any sign that she’s “in crisis”. I don’t want to wait for an emergency, but I also don’t want to give her a medication that suppresses her immune system just in case she gets sick.

Any experiences or opinions to share?

2

Here’s some information to digest, just based on my observations as a medical librarian and not to diagnose/treat/etc.

You can have asthma without wheezing. Also, different triggers aggravate asthma. All of the cleaning/allergen reduction strategies in the world won’t help if your child is not actually triggered by those allergens. You may need more time and/or more tests to figure out what the triggers are.

Parents often worry about using steroids in kids, but it is a medically sound treament program (in other words most evidence supports that the steroids work and are safe.) If you are worried by the steroids (and you have every right to be) ask for guidance from your child’s health care team. (Steroids are scary, but far less scary than a kid who can’t breathe.)

There should be an Asthma expert somewhere in your child’s health care team who can direct you to further information (maybe an education program through the local hospital or such.) Asthma symptoms can creep up and can leave you unaware of problems until a major nasty flare-up happens, and this why the preventative drugs are usually part of the treatment plan.

If you want to try to ditch the steroids you WILL need to know more about early symptoms (especially if your kid is not a wheezer.) Also talk carefully to your child’s docs BEFORE making any changes in meds.

See here for more information than you will ever need:

See especially the link called “Early Warning Signs.”

3

Also, I wanted to point out that the Pulmicort, as an inhaled steroid, has fewer potential side effects than an oral (systemic) steroid. If your child was in crisis, she might need to take a course of oral steroids, so better to have good control than to need that. Your child’s doc is already trying to minimize the time your daughter has to take it (just when her risk of attack is highest.)

4

FWIW, my son has asthma (which seems to be viral-induced) and it is almost entirely under control with Singulair. We haven’t used his inhaler in over a year.

He was diagnosed at 4. He was not hospitalized, but did have an episode that was very hard to control until he got some creepily-high dose of steroid given in the ER. After that, he used a nebulizer or inhaler regularly for a time, but then went to Singulair alone. I nervously check his lung capacity whenever he gets congested (he doesn’t tend to show symptoms) and there have been other times when he needed the inhaler, but generally he has been doing well with Singulair alone.

So yes, apparently it’s possible to treat asthma and control asthma without regular steroids. Whether that’s true or not for your daughter is something I can’t speak to. It took us some time to figure out just how “bad” his asthma was, and it may take you some time, too.

5

My son had asthma and whenever he’d have a flare-up (and sometimes they were severe) he’d go on a steri-pak. He, at times, was on a puffer for extended periods, but he didn’t like the side effects and rarely stayed on it for any length of time. He was never prescribed steroids “full time”. My SIL, on the other hand, has been on them for decades. I don’t know what the current school of thought is, but back in the day, they wanted them off the steroids rather quickly.

6

My husband had terrible asthma problems as a child, and he had to take steroids and had a nebulizer. We sleep on a waterbed due to his asthma, no mites in the mattress. If your child’s doctor deems steroids necessary, give them to her. You might also set up an appointment with a children’s allergy specialist to see if there are treatments that can be had to alleviate the allergies and thus the asthma. Mr. Clawbane’s asthma isn’t as bad (so long as he stays away from hayfields) as it was when he was a child, because he had treatments. The desensitizing treatments did help alleviate his asthma. I still make sure to carry his rescue inhaler with me if we are going out for a time, and make sure he has one with him when he goes to work or class.

7

Thanks for the replies and information, I appreciate your posts.

8

Let me be very clear, here. I won’t even use the acronym. I am not a doctor. What I tried was done with the agreement of her paediatrician.

Over the first 2 or so years my daughter was rehospitalised with high fever and respiratory infections causing breathing problems maybe 6 times. Eventually the doctors stopped calling it bronchiolitis and called it asthma. She was on a nebuliser several times a day. It wasn’t rare for the area we lived in - her daycare centre had a nebuliser there, and the kids just brought their own masks and medicines.

It got to the point where she was prescribed daily courses of ventolin and atrovent and intal forte plus pulmicort for flare-ups. She was about to be prescribed another drug, stronger than pulmicort (it’s name escapes me now) but which did have the sort of side-effects that her doctor felt it was necessary we understand before agreeing to. That was the trigger for trying to find another way. Over the next couple of years we moved my daughter from all of that, to nothing.

She has not had a serious asthma attack now for maybe 4 years, and possibly not any asthma, not even mild, for at least 2 years. I haven’t noticed cos it hasn’t been happening!

I will happily tell you her circumstances and what I did, but asthma is serious. Asthma is torture - like drowning on dry land. Asthma kills. I would hate anyone to try what I did and have their kid suffer 'cos it wasn’t right for them.

Oh, and again to be clear, it hasn’t worked as well for me. I still get asthma, though less often. And if my daughter did get asthma again, she would be back to the doctor and back on whatever he prescribed, immediately.

Mods, would outlining what we tried contravene the no-medical-advice rule?

9

It might be reassuring for you to know that I do, in fact, take this quite seriously - I have mild asthma myself, so I know what it feels like.

10

Ah, in my need to be careful I have been rude. Sorry - absolutely no intention of implying you didn’t take it seriously, but I can totally see how it might be read that way. :smack:

For “you” in para 5, please read “anyone”.

11

Please don’t mess with the prescription. As said before, it kills. Steroids are there as preventative treatment - the absence of symptoms is a good thing, but doesn’t mean they’re not needed. About a year ago, and after a decade without wheezing or medication, I landed up in hospital with an attack which came out of the blue.

Also, has the avoidance of taking the kids out with the intention of avoiding allergens come from medical advice? If so, it surprises me (unlike the cleaning of bedrooms & beds etc.).

12

Maintenance treatment with inhaled steroids in asthmatics who have more than one asthma attack a week which require rescue treatment (think albuterol inhaler) is the standard of care, lacking other mitigating factors in the individual patient.

Inhaled steroids have been demonstrated to lead to fewer attacks, better outcomes, fewer hospitalizations, fewer trips to the ER, and reduced death rates.

I don’t believe other maintenance treatments have yet been proven as effective.

13

Little kids at risk of RSV complications are often advised to avoid contact with lots of other kids during RSV season. RSV is so mild for you and I that it’s often that “little cold I started to get, but I took some Vitamin C and headed it off before it got bad”. It’s two or three days of sniffles. In a kid with respiratory issues on the other hand, it can be deadly. Last season, we had our daughter on immunizations for it that cost over $1000 per month, not covered by insurance. This year we can’t afford it, but we are minimizing her contact with other kids.

So it probably wasn’t an asthma recommendation, but it’s a good idea to prevent another RSV incident.

14

No, the not-taking-the-kids-out thing is my attempt to keep them from catching viruses. I don’t think it’s Reactive Airway Disorder, but I’m not of a mind to test it right now.

If she’d had an ongoing problem with asthma attacks, I would clearly see the need for Pulmicort (and I have heard good things about that drug). She’s going from zero medications to two medications, and I don’t have any way of knowing if she definitely needs them both. But maybe her pediatrician figures it’s too difficult to pick up on slight symptoms in a 3-yr-old, so the risks of an inhaled maintenance dose beat the risks of oral steroids during an outright attack?

I knew something was up b/c of her night cough, which began in October, but nobody believed me.

I’ve found with my own allergies/asthma (I seem to be right on the line) that removing a specific irritant eliminated my wheeze. The irritant? Cardboard boxes. We had dozens of them in storage for a couple of years, and they smelled really musty. I’ve gotten rid of almost all of them and still strain a bit at times - when my husband got out the Christmas decorations, it was awful! I’m supposed to be on a daily steroid, too, but I generally avoid it.
No offense taken, Mame, sorry if I sounded pissy. Several moms whose opinions I generally respect report that their children have benefited from chiropractic care, of all things; I was thinking perhaps that was what you’re leading up to.

15

You’re absolutely right, that if you can eliminate a trigger, then the problem may be solved. However, identifying the allergen may not ever be possible. I also get hayfever in the third week of August, without fail. But if I’m not in Suffolk at that time, I don’t get it. So it’s something which flowers, probably a crop. Whether I’ll ever track it down, I don’t know.

16

Jumping in with our experiences.

I’m an asthmatic who requires daily doses of several medications to keep breathing including an inhaled steroid. If I did not use the inhaled steroid appropriately, I’d be a sick person. I would rate my as “moderate to severe” (but not “brittle” as in I don’t crash-and-burn).

My kids are intermittent asthmatics - as in, typically when they get a respiratory infection, they start coughing. With both of them, I’m on the alert and I start them on inhaled steroids immediatelyifnotsooner.

Neither of them has proven to have symptoms enough of the time to warrant a maintenance dose of the steroid inhaler but we’d do it if we had to (both need a nasal steroid pretty much 365 days a year).

Our sitter has a daughter, same age as my Dweezil, who also has intermittent asthma, which appears on flareup. She does not put her daughter on inhaled steroids at the drop of a hat… rather, she waits until her daughter has a nasty flareup going on, which requires a trip to the doctor, antibiotics (for the secondary infection that has set in by then), and a course of oral steroids. I think I’ve finally gotten it into the sitter’s head that the minute that coughing starts, bring out the Pulmicort.

A friend’s son, also same age as Dweezil, required nebulized Pulmicort also. The son came with us on vacation. Mom thought it would be nice if son didn’t have to lug a nebulizer on vacation. So she asked their pediatrician. Who said “Ok, stop the pulmicort, just have him use the albuterol as needed”. Within 24 hours, son was coughing. Within 48, he was coughing a LOT. Within 72, we were calling local friends in California to find out where the nearest urgent-care place was. Oral steroids and antibiotics ensued.

I guess my point is: Careful and appropriate use of inhaled steroids can keep asthma under control, and prevent it from getting a lot worse - avoiding a lot of Big Guns medications (oral steroids, antibiotics), ER visits, and other fun things.

Re the OP: Discuss with your doctor of course. Consider - IF APPROPRIATE - a trial of weaning the child off the inhaled steroid (harder to do with unit-doses of Pulmicort; my kids use inhalers with 2 puffs/twice a day so easier to titrate down). When my kids are getting over a cold, I’ll wean them down carefully over a few days to see if their symptoms are remaining under control. If they feel worse, or their coughing persists/picks up, the dose goes right back up.

On rereading - you mention that your daughter was coughing and getting infections for some months. That would (to me) suggest that her condition is a bit more “ongoing” than my own kids’, and therefore longer-term use of inhaled steroids would be reasonable.

Re the risks of longer-term inhaled, vs. occasional oral: Oral steroids are not so much fun. heartburn from hell. The stuff they give the kids reportedly tastes nasty. Weight gain. Blood sugar goes wonky. Other stuff sometimes tastes bad (I remember swigging soda one time and thinking it tasted like insecticide or something). Mood swings. Fatigue. Those are all things I’d prefer to avoid.

The inhaled steroids have only minor risks I think there’s a theoretical increased risk of cataracts over many years of use, for example. There are outstanding questions on whether inhaled steroids affect bone density and height; a quick googling implies the experts aren’t too worried about that with use of the inhaled steroids for a year or two. IMO, those risks are small and handily outweighed by the risks of uncontrolled asthma.

17

Thanks! That was really helpful!

18

My asthma was missed until my mid-20s, in part because I’m not a wheezer. I do cough, I get short of breath, but things have to be pretty dire before I wheeze. Some of us just don’t. So it’s quite possible to have asthma without the classical wheeze.

I understand. They’re powerful drugs. You’re concerned.

Because I was never diagnosed as a kid I suffered through a LOT of upper respiratory infections and had pneumonia 6 or 7 times (that I remember). I had a lot of bronchitis. Maybe steroids would have avoided all that, the missed school, the missed get togethers with friends, the missed camping trips and field trips and ruined vacations. Or maybe not. But from what I’ve learned I think I might have been better off with a little more medication BEFORE I got sick.

As an adult I have had courses of steroids, including oral, from time to time. No, I don’t like them. On the other hand, they DO work and can be very effective. I haven’t had pneumonia in… oh, at least two decades. I miss a lot less of my life due to respiratory infections. Short courses, at least, only minimally raise your risk of things like cataracts and bone problems - so far, my docs say I have NO sign of cataracts (I wear sunglasses just about all the time outside, which might have something to do with that) and I make sure I get lots of calcium and weight-bearing exercise for bone health - which ALL women should be doing!

So, I understand your need for caution but do understand that steroids - when used properly - are good drugs indeed and can spare a lot of misery.

By all means - ask for a second opinion where your child’s treatment is concerned. Usual disclaimer - I am not a doctor and the plural of anecdote is not data. I am merely relating my own personal experience here.

That only works if the items you’re removing are triggers. Has your child seen an allergist?

Inhaled steroids have a minimal effect on system-wide immunity. That is, in fact, while they developed inhaled delivery - it gets the drug to where it most needs to be with minimal impact on the rest of the body. Yes, if there’s a high dose there’s an increased risk for things like thrush. If you have untreated asthma you also have an increased risk for things like pneumonia and, uh, yeah, in extreme cases even death. So for your particular child the risks and benefits have to be weighed.

It’s very important to consider that inhaled steroids can PREVENT a crisis. Inhaled steroids can prevent the need for oral steroids, which are the ones with the worse side effects. The key here is control and prevention.

19

Just to reiterate what Snowcarpet said, you have to distinguish b/w inhaled and oral steroids. I have been on inhaled steroids, and expressed concerns to my doctor about them, and he said the worrisome side effects stem primarily from oral steroids, not inhaled steroids. (Something about inhaled steroids not getting into your bloodstream so much. I don’t know. IANAD, I can only relate what the doctor told me).

I had moderate asthma as a kid, and didn’t need inhaled steroids. I was very active (varsity letterman in soccer, etc.). My asthma, curiously, got worse in graduate school, and I found I needed to use the inhaled steroid in the winter (cold + exercise = can’t breathe). Now I just use one when I get bronchitis (which happens pretty often living in a dirty city like Beirut). So basically I use as needed. Don’t know if your kid’s asthma would allow that, but that’s what I did, and my doctor supported this.

20

Dropping in to say that I had severe childhood asthma as a tiny kid - not up to the level of O2 tent in hospital - but pretty bad. Any sort of exertion would have me wheezing away and almost completely unable to breathe. Complete with nighttime asthma attacks. Those were always really fun for my parents - I remember waking up to find Dad sitting by my bed with the nebulizer mask held an inch away from my face a few times.

I was on at least two oral medications from my earliest memory – one was Slo-Bid, and another was this nasty-tasting red liquid that came in a brown bottle with colored squares on the label. I had to have a spoonful of that every day. I wish to Og I could remember what that was called.

Top that with a nebulizer for every time I had an attack. We went through two versions of nebulizers - one was this cool vaguely steampunkish setup with mysterious glass jars, tubing, and cork balls. The other, more modern one, was a plain plastic box that was not at all interesting other than weighing a ton and being suitable for mashing one’s toes off when dropped.

As I got older, I got gradually weaned off the oral medications and stuck with the nebulizer, which also got phased out to a Ventolin inhaler for emergencies and for preemptive dosing before my workouts on the HS swim team. (The chlorine apparently was a mild trigger)

While I also wheezed a lot during attacks, I also had attacks where I would simply stop being able to breathe. Just lots of gasping, no classical wheeze. I got pretty used to putting a hand on my throat to see if I was having difficulty breathing or if it was my imagination.

Respiratory infections were terrible for me and everyone involved because they meant that I’d be sicker than a dog with the cough/cold medication plus the maintenance asthma medications, plus the nebulizer. Coughs triggered attacks ad nauseam.

But fortunately, after high school, I grew out of my asthma, thank the hundred little gods. And my rate of respiratory infections also dropped to almost none, come to think of it. The only one that I’ve had in the last year came from my boss, who gave me a cough that took weeks to go away. Sharing is NOT caring in this case. :stuck_out_tongue: