I’m starting to wonder what’s up with my kid - she keeps asking for her nebulizer, and saying she’s “wheezing”, but I don’t hear it. Is she just learning when she needs it before I can actually hear the whistle (which would be cool) or is she craving the drug?
I’ve suggested we sit in her chair and read a book or play with blocks together instead, and she says no, she’s wheezing and needs her “nebooeyezer”, so I don’t think it’s just that she needs the down time or the time together. I’ve stopped paying attention to her while she’s using the nebulizer, just in case, but that hasn’t stopped the requests.
She’s not quite 3, and she’s not terribly verbal yet, so I can’t really ask her what’s going on more than that.
*I’ve been taking albuterol for over 20 years. I wouldn’t say it’s addictive in the slightest. And I’ve had my fair share of addictive substances OTC or otherwise. I never feel like I NEED it, when I really don’t, and for that matter, it doesn’t have any dependent effects like Afrin does (after the nose spray wears off, you become even more congested, and so, you need to take another hit. It can be an ugly, downward spiral). I’ve never experiences any of that with albuterol.
My guess, is that if she’s saying she needs a dose, she probably does. Wheezing usually shows up when it’s too late. My chest can feel tight, and exhaling becomes labored way before the wheezing kicks in – if ever. It feels like your breathing is shallow, and you can’t get enough air. I wouldn’t worry about letting her have another treatment, if she’s communicating that she feels her chest is tight.
Albuterol is not addictive. That is to say that it doesn’t satisfy the usual criteria for addiction (uncontrolled, compulsive use +/- dose escalation, excessive time/energy spent seaching for a supply, neglected social and other activities, etc.)
However, excessive use of albuterol is associated with increased morbidity and even mortality from asthma. Bottom line, then, is that you should get your daughter seen pronto by a pediatric respirologist or allergist.
As an aside, in adults, use of albuterol or similar drugs more than twice a week is an indication to begin treatment with inhaled steroids. Although the word “steroids” might conjure up images of horrible side effects, that is something pretty well confined to long term use of oral or IV preparations. Inhaled steroids have little, if any, systemic effect or side effect when used properly (with a spacer, followed by a good mouth rinse, . . . )
Thank you! This is exactly the sort of first-hand anecdotal experience that I lack, and it’s good to hear from someone who can pronounce their "r"s and make complete sentences!
Thanks. We’re staying within the limits of her prescription, so I agree.
Yep. We have a doctor for doctorey advice. What I really needed was the factual information requested in the title and the anecdotal experience of someone else with asthma/bronchioconstriction.
Whew! Thanks for that.
I’ll discuss it with her pediatrician at our next visit (2 weeks away). She’s a micropreemie who spent more than a month on a vent (but with low added oxygen levels) at birth, so we’re acutely aware of her lung fragility.
She usually only needs it when she’s fighting a respiratory infection, so we’ve been loathe to move to anything that’s a maintenance sort of therapy. This last chest cold (started just before Christmas) has been a doozy, though. For some reason, unasked, I started tracking her nebulizer use at the beginning of the month, as well as tracking the whole household’s colds. She used it once a day for two days at the beginning of the month when my son had a cold - she didn’t develop other symptoms then - and then nothing until the 21st, and she was snotty and coughing by the 23rd. I’m hoping keeping good track of her respiratory patterns and the cold symptoms of the whole household is useful in determining whether this is still a cold related symptom or if she is developing a more chronic condition.
Huh. Can you tell me more about that? My doc didn’t mention it, but my daughter always asks for a drink of water when she’s done with the nebulizer. I told my doctor that and she said it’s probably because the albuterol is bitter, but she didn’t say that a mouth rinse was needed, just that it was okay.
Thanks. If we decide it’s time to move into preventative mode instead of bronchiodilators, I’ll ask my doctor about it.
For adults, at least, after taking puffs of inhaled steroids it’s advisable to gargle and then spit it out. Doing so removes any steroid that’s landed on the back of the throat and/or in and around the mouth. That’s good for two reasons:
it lessens the amount of steroid swallowed and thence absorbed into the circulation (where it might promote unwanted effects)
it lessens the amount of steroid available that might cause local immunosuppression and thus lead to things such as oral thrush (yeast infection)
I’ve been on albuterol for around 25 years. I have gone through periods where I over-used it; my doctor expalined that albuterol can make your lungs very open, so that what is normal can feel constricted. I don’t know if he knew what the hell he was talking about, but there you have it.
Also–highly anecdotal–during one period of overuse I seemed to suffer from chemical withdrawal when I ran out once–agonizing headache, violent nausea and vomiting. Basically, the same chemical withdrawal symptoms I have experienced with at least one other RX medication. Symptoms disappeared within 30 minutes of getting my refill. The pharmacist expressed skepticism that my symptoms were withdrawal, but the correlation was highly suggestive to me.
I think KarlGauss and WhyNot are getting confused. As KarlGauss said, a water rinse after an inhaled steroid is recommended. It can get pretty nasty if you don’t. WhyNot had not heard about this because Albuterol is not an inhaled steroid, so no water rinse is needed.
Albuterol is not physically addictive as far as I know, but I’m sure a psychological dependence is possible. Frequent use of Albuterol, simply means that more preventative treatment is needed. There are inhalers that aren’t steroids, but could be used as a temporary preventative measure when your daughter gets sick again. Steroid inhalers would not serve this purpose since they take a while to take effect and actually lower your immunity when you start them. I am not close to a doctor, so I will not mention specifics. I only have a life of experience with asthma.
My daughter is 9 instead of 3, but a couple months ago I was wondering the same thing – she often uses her nebulizer when I can’t hear any wheezing, and I wondered if she was using it more often than she should. Then I mentioned it to her doctor, and he said that it’s certainly possible for her to feel chest tightness and have slight breathing trouble without hearing it. He listened to her chest and said she was actually slightly congested then, even though we couldn’t hear anything audibly.
I’m going to second the information - you certainly can feel congested/insufficient air without wheezing at all. In fact, my asthma went undiagnosed for years because I just don’t wheeze much (in me, it manifests more as a cough and being out of breath)
The good part of this is that she is aware of what’s going in her body and is comfortable asking for what she needs. The bad part is that more frequent asking suggests it is time to talk to a doctor again.
I certainly understand the reluctance to add medications to your daughter’s routine, however, a short course of more intensive treatment can not only make her more comfortable but also shorten the duration of an inflammatory episode and make complications such as secondary infections less likely.
And, let’s face it, if she needs a maintenance therapy it’s better that she get it than not. I sincerely hope it’s not necessary, but as someone who spent far too much of my early life uncomfortable to miserable and feeling sickly and weak and not knowing why, I can also tell you that properly treating respiratory problems makes life ever so much better.
And, of course, talk to her doctor. It could be just a transitory thing due to a respiratory infection, but that can only be determined by real life examination by a true medical professional, as you well know.
The albuterol tastes kinda gross. And after finally getting used to Old Albuterol, they changed the formulation to eliminate CFC’s and I now have a whole new flavor of grotty to get used to. Mind you, it beats not being able to breathe and it’s far from the worst thing I’ve ever tasted, but I really do prefer to rinse that crap out of my mouth.
The bit on the packaging actually recommends drinking 8 oz of water after inhaling. Keep in mind, too, that between labored breathing and mucus production, an asthmatic probably could use an extra dose of fluids anyhow.
Although I seem to have grown out of most of my allergies after 21 years, during the period when I was worst I could almost always feel the onset of constriction before anybody, especially an outside observer, could ever hear an actual sound, so I wouldn’t say that just because you can’t hear anything doesn’t mean she doesn’t have symptoms apparent to her.
That said my basic instinct is against overuse of ANY sort of medication, and I second (third, fourth, whatever) consulting with the doctor on that, especially for a young child.
Thanks everyone for the replies! I’m feeling better about her noticing her own symptoms and asking for help before it gets bad enough that I hear it. She only did end up asking for it once yesterday, and that’s well within her prescribed dosing (which is a use every 3 to 4 hours during a cold).
There’s a reluctance to add medications, but there’s also a reluctance to add a chronic diagnosis to her chart. That’s not just a philosophical reluctance, but a practical one: insurance. Once she’s officially diagnosed as “asthmatic”, it becomes a pre-existing condition, with all the ick and financial woes that causes should we have to switch providers or go uninsured for any period of time. Having gone through that once with my son (diagnosis: scoliosis), I’m not eager to repeat it with her.
But of course, reality will win out. If my logs show that she’s using the Albuterol more than is good for her, we’ll do whatever it takes to make her more comfortable and healthy.
Again, there are now clear evidence-based consensus guidelines to assist in the management of asthma (for both adults and kids). Regarding inhaled corticosteroids (ICS), from a recent Canadian review and consensus guidelines, we have:
As you can see, then, use of inhaled steroids is considered a mainstay of contemporary asthma therapy for kids. That is not just my opinion (although I most certainly agree with it) but, rather, the advice and recommendation of expert panels from around the world in consensus guidelines they’ve developed.
I guess I’m suprised that a short course of inhaled steroids is recommended. I thought they took some time to take effect. I’m pretty familiar with the rest of your post, but I am not a doctor so can only offer experience with my own asthma treatment.
Inhaled steroids do take longer than something like albuterol to take effect, but in the past I’ve noticed a change within 24 hours. They’re at least as fast as antibiotics. ICS also have less systemic effects, such as lowered overall immunity, than oral steroids, which they are often confused with.
Bottom line, final diagnosis and treatment requires a doctor. I understand the reluctance to put a chronic condition on record, and the fear of losing insurance - when I lost my job in November I lost my health insurance. None of the short term companies will touch me, despite the fact I’m deemed healthy enough to fly airplanes and I have NEVER been hospitalized for my asthma.
Whereas I have seven times (though not since the age of seven), and yet have no problems getting insurance anywhere.
IMHO, the greatest benefit to the nebulizer is that it promotes calm. When I had asthma attacks as a youngin, I tended to get panicky, which of course made things worse. So, mother would hie me off to the hospital to go a round with a nebulizer, and being around all those people who obviously were supposed to know what they were doing calmed me down. After a year or two, just the sound of the nebulizer running improved my breathing, without ever actually putting on the mask.
Interesting. My daughter has an albuterol inhaler and an albuterol nebulizer. Both of them, instead of having am in-the-mouth piece like an adult tool, has a mask sort of thing which fits over her nose and mouth. The dosage, according to my doctor, is the same with either method. But the nebulizer works about twice as well. When I told our doctor that, she said yeah, that’s what all the mothers say, even though theoretically they should work equally well.
We keep the inhaler up to date and handy for when we’re away from the house or short on time, but prefer the nebulizer when it’s practical.
On the insurance topic: my understanding is that if you keep your insurance, or get new within 30 days of canceling the old, the Health Insurance Portability Act (I’m not sure if I got the name of that exactly right) means that they have to include coverage for pre-existing conditions if they take you as a customer. My problems with my son’s scoliosis came about because I lost insurance from one job and didn’t get a private policy within the right time period. With that lapse in coverage, my "new’ company (which was actually the *same *company as my old policy, but now a private one instead of group) pounced on that little money saving opportunity and declared his scoliosis pre-existing and wouldn’t cover it, although he’s covered for everything else. Bastards.
Before Albuterol I took Medi-Haler as emergency relief starting in the 1960’s. One canister lasted 2 to 3 years. I didn’t carry it with me. It stayed at home in my catch all drawer. I usually had to wash it before using it because it would get covered with dust. Then in 1980’s after nearly 20 years of Medi-Haler use and a grand total of less than a dozen canisters they said I shouldn’t use MH anymore because it made my heart beat strongly for a few minutes and I should switch to Albuterol. One month on Albuterol and the canister has never left my pocket since. I use about one canister every 3 weeks. When I haven’t had a dose in a few hours I start getting a strong desire for it. Even with no indication of asthma at all. I try to lock it in my desk drawer to forget it. Finally I give in and take another puff.
I tried cigarettes in my younger days. They didn’t happen to exacerbate my asthma as they apparently were not part of the allergy. I never developed a strong desire to continue smoking and I would frequently forget about them entirely for weeks at a time. I eventually just forgot about them completely. I drink alcohol occasionally. A bottle of scotch lasts for several years. In other words I am not an addictive type of person. But Albuterol I can’t stop. Everyone says it’s not addictive. Yet everyone I know that starts on it keeps puffing on it everyday and their doctors say that’s too much you should try this new thing. I’ve tried several new things.
The latest is Dulera. I still want and use the Albuterol. And the side effects of Albuterol is much less than hives, hoarsness, and acne caused by the other things. Vanceril sent me to the ER with hives twice. Aerobid and Dulera both cause acne worse than when I was a teenager. And I can no longer sing when taking those two. I want to change back to medi-haler. It was far safer for me and apparently not addictive. But they don’t make it anymore.
Ask about Bricanyl or Brethine (terbutaline sulfate). It was the only rescue inhaler I ever used. All short term bronchodilators will cause your heart rate to increase, though.
