Nope, I am totally for evidence based medicine. Very medically conservative, I am. Not chiropracty, not acupuncture, not herbal, not spiritual, not reflexology. Can just about cope with the idea of therapeutic massage.
The original question was “are steroids really necessary”. My anecdote says no, not for my child. But as someone else pointed out, the plural of anecdote is not data.
Look, it is your kid. As the parent, you are right to be concerned, and it is your right to BE concerned. Second opinion time? At the least it might make you more comfortable with what has been prescribed.
(Can I just share my least favourite parent story? You know how hard we all try not to criticise others parenting decisions? While my daughter was gettting sick all the time and being rehospitalised, there was another kid at the same childcare centre who was also getting sick a lot, but the mother kept bringng the kid into the centre. One time she announced proudly that the doctors had prescribed antibiotics for the kid’s latest infection (middle ear, I think it was) but she’d done better than that. No antibiotics messing up HER kid’s natural balance. Nope, she was treating the toddler with triple doses of infant panadol instead. Happily, I was not the only parent present who argued with her about it.)
Oh, and the cardboard box allergy could be to tiny paper particles, or more likely to one of the moulds that grows on paper.
I sometimes wonder if the reluctance of parents of asthmatic children to use daily medications, including inhaled steroids, stems in part from a desire to want a “normal” child. That is, a child who does not have a chronic disease or condition. Daily dosing is a continual reminder that something is Not Quite Perfect, whereas avoiding daily medications allow for a certain illusion of normality that may or may not synch with reality.
In fact, a child with asthma can be analogous to a child missing a body part. If a child is missing a toe or two the issue may be minor in the overall scheme of things and require no special attention - which would be the counterpart to a child with asthma in remission or of a very mild and intermittant nature. On the other hand, a child missing a leg requires a prosthesis to walk, and a child with severe asthma requires daily medications to remain healthy. A child with severe but well-controlled asthma may APPEAR normal outside of medication times, but can no more function without those medications than an amputee child would walk without the artificial leg.
The question is always where does a child fall on the spectrum between perfect lungs and severely asthmatic. I have a neice in the latter category who has required multiple daily medications all her life. Nonetheless, she has played trombone in a marching band, won martial arts tournaments, danced ballet, participated in sports, ridden horses, and has had a very active life. This would NOT have been possible without the medications that keep her lungs functional. Indeed, she was much more the athlete as a child than her aunt (me), who has a MUCH milder case of asthma that was, regretably, entirely untreated for decades. She is an example of what PROPER AND APPROPRIATE medication can do for a child who truly needs it. Yes, she is the shortest member of her family - but then, none of us on her mother’s side are tall anyhow. Even so, better she lost an inch or even two of adult height and be as healthy as possible than be taller but debilitated or, even worse, dead at an early age.
I can’t know how the OP’s child is - even if we met in real life, I am not a doctor or in any way qualified to make such a judgement. I again urge a second opinion if that would lay doubts to rest. Meanwhile, do not be afraid of proper medication, the goal always being to have the benefits outweigh the risks. And be cautious listening to the horror stories of people who had asthma as kids 30 years ago - the newer pharmaceuticals are more effective and have less severe side effect than what was used decades ago.
I think this is possible, though through my lens it’s more of a “I wish my kid didn’t have to suffer the pain and fear not just of the attacks, but of forgetting his inhaler, or being with people who don’t know how to use it when he can’t communicate. I wish he was normal because it’s easier than making sure we have an extra prescription on hand as it’s nearly impossible to tell when the inhalers are empty, and I wish I could let him run and play football with the other kids.” rather than, “I deserve a perfect child, dammit!” (Although I’m sure there’s that, too, in some parents.)
I think (as a parent facing the same dilemma as fessie, but earlier in the game) it’s mostly, however, the fact that STEROIDS are big and scary and have been the topic of way too many Health Watch type scare stories. STEROIDS are what BAD ATHLETES SHOOT UP WITH and they MAKE YOUR PENIS SMALLER and YOU’LL GROW BOOBS and go into 'ROID RAGE and KILL YOUR PARENTS IN THEIR SLEEP. We’ve had it pounded into us over and over for several decades now that STEROIDS are the devil’s instrument.
Whatdaya mean, those steroids are different and the dosing is different and it’s different when you really need them? They’re STEROIDS, dammit! They *must *be evil! The lady on the news said so.
This is the subtext going on in your (and by “your”, I mean “my”) head while you’re trying to make sound medical decisions about very real risks and benefits.
In that case, it’s not unlike people being concerned about using morphine after surgery or an accident because IT’S A DRUG!!! IT’S LIKE HEROIN AND THAT BAD STUFF JUNKIES USE AND YOU CAN GET ADDICTED!!!
Well, yeah - on the other hand, if you’re in agonizing pain it’s a god-send.
Same thing with steroids - yes, they can be overused, abused, and misused.
All these big, scary drugs are tools and like any tools they can be used properly or improperly. Though I can understand how healthy folks dealing with these issues for the first time can suffer misinformation and confusion.
I was diagnosed with asthma as a side effect of my vasomotor rhinitis a couple of years ago. Initially, I needed both the antihistamines and the inhaled steroids prescribed to me in order to regulate the way my body reacted to the world around me. (I’ve got a LOT of things that can trigger both a histamine reaction and an asthma attack, and it’s easily summed up as “chemically sensitive.”) Initially, I really needed both the inhaler and the antihistamines every day as prescribed to be able to cope with the world. Nowadays, I don’t need it on a regular basis, but I’m a bit different because, even with having both on a regular schedule, in practice, it was prevention that dulled my reaction to triggers and reduced the occurrences in which I’d actually need to reach for an emergency inhaler. I didn’t have much of anything in the way of side effects, but as usual, YMMV.
I might’ve had asthma when I was younger, but it certainly didn’t affect me the way it did once I developed more severe reactions to triggers around me. If I were you, I’d go along with what the doctor prescribes (and possibly get a second opinion if you still have doubts) until you have the asthma under control. Once you get to that point, you can discuss a possible change in the treatment as needed. (I’m not a doctor, and this wouldn’t be considered “official” medical advice.)
Amen to that. If I hadn’t had the full-on treatment as a kid, I’m reasonably sure I wouldn’t be here today given the attacks that I had at the time. I’m a lot shorter than my younger siblings, but I just rag on them about being older siblings by proxy due to height. Besides, height isn’t an inhibiting factor when it comes to offering to kneecap people.
It’s more the fact that for 2 years and 10 months, I had a kid whose lungs worked just fine. Now all of a sudden they don’t, and I’m supposed to “fix” HER? F that, I wanna know WHO is putting WHAT crap into our air, and how do I get them to STOP. Or if it’s something in this house that we bought last year, I want to find it, bleach it, throw it away, stomp it, burn it, get a fricking exorcist in here if necessary to remove whatever’s threatening MY CHILD.
I’m angry, is what it is. She was fine, before. Something is messing with her, and I don’t see why SHE should have to be the one to change.
I threw away a big-ass pile of boxes yesterday, vacuumed like crazy and washed the walls and windows in their room. May not have made any difference, but probably didn’t hurt.
I also ordered a book on Ways Your House May Be Killing You. I’d really like to go tearing out some ductwork, but it would probably be a good idea to figure out what I’m doing first.
We did see their pediatrician today, and thanks to the answers and insights so kindly provided here, I was able to briefly (because that’s all you ever get with a doctor anymore) touch on my questions and concerns. The part about inhaled steroids on a maintenance dosage = low side effects, especially compared to emergency orals in a crisis makes a lot of sense. Snowcarpet, thank you for explaining that, and for your link to signs of crisis — it’s tough to catch subtle cues in a 3-yr-old, and that is worrisome.
Therefore, it’s Pulmicort until April, and Singulair until June, assuming gradual test reductions in dosage prove successful. Fingers crossed.
If it’s oral steroids you’re talking about, “current thinking” still is"off them as soon as possible". They’re cheap, they work a treat, but they have side effects that range from the annoying/uncomfortable (short-term) to serious and very dangerous (long-term use).
For Fessie and anyone else dealing with asthma: There are a number of very informative books out there that discuss asthma. I haven’t read any in recent years. But I remember the day, back in 1990 (I think), when I stumbled across Allan Weinstein’s book on the subject at a B. Dalton bookstore near my office. I found it quite literally life-changing - there was so much information right there for the asking (I bought it at lunchtime, and kept sneaking it out of my desk to read at work). That particular book is outdated (unless there’s a revision I haven’t heard of) but there are others out there that can really inform you and make you feel more in control of things. Take any of the ones that deal with Buteyko (a breathing technique) with a large grain of salt; from what I understand about that, its claim to “cure” asthma is pure snake-oil.
Oh - the Weinstein book that I said is out of date is “Asthma”, from 1988. He co-authored another one, in 1994, which is doubtless much more current but I haven’t read it.
Make an appointment with a child allergy specialist! (Talk to her doctor and ask him to recommend someone, they could even set up a referral appointment for you.) They may very well be able to help you get to the bottom of what some of her triggers may be. (It could be diet as well.) The allergist might be able to help desenstize your little one, so that later in life her allergies/asthma aren’t as bad. You won’t know if these things are possible though, until you make that appointment and ask the questions.
Yep, you’re absolutely right, that was one of the reasons for the appointment — I just need to give her time to completely recover from the RSV. Her twin brother still has some symptoms.
As per Qadgop, it is reasonable to treat asthma with a steroid puffer if symptoms are not well controlled – if they have symptoms more than twice a day, twice a week, or two nights per month. Inhaled steroid puffers have fewer side effects than oral steroids, but work slightly less well.
Asthma can be tough to diagnose before the age of five. Diagnosis can be confirmed by spirometry, a tough test to do in infants. Other problems, including bronchiolitis and RSV, cause asthma symptoms for a short period of time. Allergies can trigger attacks - and by avoiding these allergens, medicines can often be reduced. Not everything that wheezes is asthma, and many kids outgrow it.
Many parents fear steroids, but they are pretty safe when used properly. Steroid puffers are expensive, and this is a common reason some parents don’t like them. Others worry about effects on growth, etc. Maybe some parents want a “normal” child and avoid puffers, but I’ve never heard a parent admit this.
Talk with your doctor about alternatives to steroids. There are other medicines which reduce tracheal inflammation.
As someone who was told for years that MY lungs “worked just fine” when actually they didn’t, I have to (even if you don’t want to hear it) question that assumption. Perhaps her lungs functioned well enough to avoid showing overt symptoms, but there is a possibility that they didn’t work quite as well as her peers. This only became noticable with the RSV infection, which can impact lung function in even the healthiest, non-asthmatic child.
It may be your child has a pre-diposition to asthma-like symptoms. If such are not treated promptly, when they first appear, you wind up with a long duration of symptoms and longer duration of medication. This is why I, someone who’s asthma is so minimal that when I’m asymptomatic doctors miss it entirely, will not hesistate to start medicating asthma whenever I get a cold, flu, or other respiratory-affecting infection. It may be that, rather than daily steroids (of any sort) you child will, in the future, merely need to pay attention only during infections or in particular and specific situation. But, of course, that is only wild speculation on my part and that is, of course, why we have doctors to consult in real life.
Meanwhile, if there is inflammation right now it needs to be dealt with.
While your efforts and impulses are admirable, you don’t have infinite energy. I encourage you to seek the true, root causes of your child’s problems. If the trouble is in her diet then manical dusting will do nothing (well, you’ll have a really clean house, but it won’t solve the medical issue). If the problem is respiratory viruses, then sueing the local powerplant for pollution will not solve the problem.
It can be difficult, tedious, and aggravating to find the triggers that cause your child distress, and so tempting to grasp at the first suggestion given. I urge patience and discipline on your part. Although the journey is aggravating the destination - true relief for your daughter - is well worth the effort.
Understandably, you’re angry. However, I want to mention the possibility that may be she wasn’t quite as fine as you thought, in which case the exacerbation may be a blessing in disguise. You have been alerted to a problem before something even more frightening/anger-inducing occurs, or there is damage done. If your child does has asthma than it was caught many years earlier in life than mine was, and while you might not think so now, in some ways it is much better to know earlier than later.
You CERTAINLY are fortunate not to have endured what my sister did in regards to my neice - MONTHS of hospitalizations with life-threatening asthma attacks until they got the problem under control. You may not find it reassuring, but in fact the delay in diagnosis may actually be an indiciation your daughter’s problem is relatively mild.
Except such frantic housecleaning may exhaust you. And I’m concerned about that. You MUST focus your energies towards finding the true problems and causes here. Certainly, if such exercise relieves anger and tension it’s a good thing, but if dust/boxes/whatever are not the source of the problem then endlessly scrubbing the house may not be the most efficient use of your time and energy
Yes, please keep a cool head here. Don’t tear out the ductwork until you actually do know it is necessary - you might need that time/money/energy for other things.
Or even an older child - as I mentioned, my asthma went undiagnosed for decades. That did me no good. If your child does have a respiratory problem I strongly urge that she get all appropriate treatment whenever it is indicated. It will definitely improve her quality of life as well as her health.
If the treatment is effective in reducing the inflammation then I would expect that you will, indeed, be able to reduce dosages or perhaps eliminate some or all medications as a daily thing. But, again, she should probably be watched for future symptoms with infections, and if appropriate medicated during colds/flu/whatever.
I realize it’s upsetting to have an ill child, but treatment for these conditions has advanced greatly in recent years. At least we live at a time when children with asthma can use medication to lead much more normal lives than in the past.
I developed asthma at the age of 44, so for 44 years I had normal lungs and then suddenly I didn’t. I’ve figured out some of my triggers, but not all. Strong perfumes in cleaning products in one… keep that in mind when maniac cleaning! Another one is a rapid change in the weather, especially a fast moving cold front (pretty hard to control weather!)
Once your child is a little older, she’ll be able to tell you how she’s feeling and it will be much easier for you to manage. Hang in there!
Yes, I’m referring to the oral steroids. He hated the short-term side effects. I’d ge him through the step-down dosage (usually a couple times per year).
My SIL has been on the oral for ages. I just don’t understand her doctor’s reasoning. However, she’s one of those people who will find a doctor who acquiesces to her wishes. I believe this is part of the reason her general health is so fucked up.
One ray of hope for the OP… In my observation, many kids with asthma grow out of it (Kid Kalhoun did). It’s the adult onset crew who tend to be haunted by it for the rest of their lives. I have nothing to cite…but I’ve seen it work out that way a lot. (Crosses fingers)
Quick note to you allergy/asthma sufferers — if your symptoms are worse at home during the winter, there’s a book that might help you.
It’s called My House is Killing Me by Jeffrey May, and despite the sensational title, it’s very factual and anecdotal, full of sensible suggestions. The author approaches indoor air quality issues like a true scientist. I bought the book on the recommendation of our home inspectors.
In a perfect world, we’d all be able to have our homes tested to see if they had mold, or a mite infestation, bugs, whatever. I learned that, in our area at least, such testing runs about $2,000. Anything less than that is a waste of money – one company said for $250 they’d test our “air quality” by taking an indoor and an outdoor sample and comparing the two. Which basically tells you nothing - it doesn’t do any good to know you’ve “got mold” if you don’t know where it’s coming from.
The information in his book is too broad for a simple synopsis here, but I’ve been able to form an action plan based on my specific pattern of symptoms. The two main goals are to strictly limit moisture in and around the home, and to clean likely sources of mold and mites (such as our ducts, couch and carpeting).
He describes exactly what a truly thorough duct cleaning involves, so that you can grill your contractor and make sure it’s done right.
We can’t afford a $500 system cleaning right now, but we can buy two radiant space heaters for our bedrooms (which tend to be chilly anyway) so that we can turn the furnace down at night and not have so much dirty air blowing around. I’ve been much worse since the temps went down and the furnace has been running all day and night; my son’s on Claritin now.
The book is also kind of funny - this guy is fascinated by microbial irritants and is always pfutzing around with samples, sometimes to his detriment. He’ll talk about examining this or that, and then accidentally inhaling a little and next thing you know he can’t breathe. It’s kind of amazing he’s survived contact with all of these various irritants - our home inspectors got out of the air quality field b/c they were sick of getting sick!
