Monday, June 12, 2006

Asthma

Dear Lisa,

My son has Asthma and my pediatrician prescribed Albuterol to be used on as needed basis for when his Asthma acts up. The problem is whenever he gets a runny nose and cough, I can’t tell if it is from a cold, allergies or his Asthma. Since I’m not sure, I don’t use the Albuterol but then he usually ends up at the doctors and it turns out that he’s wheezing. Then I feel bad that I didn’t start the Albuterol, but at the same time, I don’t want to give him the medication if he doesn’t need it. Is there a way to tell if the cough is from Asthma or just a cold or allergies?

“Is the cough from Asthma in N.J.”

Dear “Is the cough from Asthma”,

Your question is a common question that I hear from parents of children with Asthma all of the time. The important thing to understand is that a runny nose or Rhinitis, regardless of the cause may contribute to the worsening of Asthma. Interestingly, Allergic Rhinitis is a contributing factor in the development and persistence of Asthma. (1, 2) Therefore it is important to treat the cough and runny nose, regardless of its cause, in order to help keep a child's Asthma under control.

If your child has been diagnosed with Asthma by a healthcare professional and has a history of repeated airway obstruction relieved by a bronchodilator ( such as Albuterol), then the administration of Albuterol is the proper treatment. In addition, effective treatment of the runny nose with the use of inhaled nasal steroids and /or antihistamine-decongestant preparations should be an integral part of your Asthma management plan. (2, 3)

When you treat your child with Albuterol you should see an improvement in his cough and work of breathing that lasts 4 to 6 hours. If you do not appreciate an improvement in his symptoms or if the improvement does not last for 4 to 6 hours your son should be evaluated by your Pediatrician. The important thing to remember is Albuterol is intended for intermittent use; or use on an as needed basis. It is not inteneded for everyday use.

Everyday use of Albuterol on a regular basis could be detrimental to your child, and a sign that your son’s Asthma is out of control. Albuterol does not address the underlying inflammation, which is the hallmark of Asthma, and may give you the false reassurance that your son is doing better than he really is.

Studies have shown that there is an association between the everyday use of Beta-agonists (Albuterol) and the increased risk of death or near death. (4) When the researchers talk about everyday use of Albuterol, they are not talking about using Albuterol everyday over the span of a week or two during an acute exacerbation. The concern is meant for long term, everyday use of Albuterol on a regular basis, especially when there is no daily maintenance medication being used (such as inhaled steroids or leukotriene inhibitors).

This information is not intended to alarm you, but to reinforce the importance of close follow-up with your health care provider and monitoring for over use of Albuterol. If you do find that your son needs Albuterol more than twice per week on a regular basis, this is a sign that his Asthma is persistent and not in good control. This situation warrants an evaluation by your Pediatrician and the addition of a daily maintenance medication.

Lastly if your son's nasal symptoms worsen or persist beyond 10 days it is a good idea to have him evaluated. If this is the case, he may need an adjustment in his allergy medication or need to be checked for Sinusitis. If left untreated, both Sinusitis and Allergic Rhinitis can cause your son’s Asthma to persisit and his condition to worsen.

References:
(1)Linneberg, A., Henrik, N., Frolund, L., Madsen, F., Dirksen, A., Jorgensen, T. The link between allergic rhinitis and allergic asthma: a prospective population-based study. The Copengagen Allergy Study. Allergy. 2002;57:1048-1052.
(2) Hogan, M., Wilson, N. Asthma in the School-Aged Child. Pediatric Annals. 2003;32:23-24.
(3) Stelmach,R, Nunes, M., Rubeiro, M., Cukier, A. Effect of treating allergic rhinitis with corticosteroids in patients with mild-to-moderate persistent Asthma. Chest. 2005;128:3140-3147.
(4) Spitzer, W., Suissa, S., Ernst, P. The use of beta-agonists and the risk of death and near death from asthma. N England J Med. 1992;326:501-559

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Website

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