Child having difficulty in breathing and neck ultrasound is negative. What could be the problem?
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My daughter who is 10, has been having difficulty breathing, feeling like there is a bubble in throat and tasting blood, She also complains of headaches. This has been going on for 2 weeks. The doctors have been treating her for asthma, its still not getting better. She had a neck ultrasound and it came back negative. She is a cross country runner and now she can't even walk up and down stairs without stopping to get her breath.
Posted Tue, 10 Dec 2013 in Asthma and Allergy
Answered by Dr. Prahlad Duggal 48 minutes later
Brief Answer: Antibioics, SABA, LABA and inhalers Detailed Answer: Hi, Thanks for your query. You have stated that your daughter is a known asthma patient and uses inhalers in winters and during acute episodes. Presently she is being treated for asthma but the condition is not improving. The infective conditions which can give rise to such condition can be: 1. Croup 2. Bronchiolitis 3. Pneumonia These conditions will present with acute symptoms and fever and other signs of acute infection are usually there. Few lesions can be a cause of mechanical obstruction in the upper respiratory passage like laryngeal papillomatosis, epiglottitis etc. An ultrasound may or may not be informative about these conditions. Noisy breathing/stridor may be present with these conditions. Few things which I would like to know are: 1. Noisy breathing if present 2. Fever if any 3. TLC, DLC reports if any 4. Pulmonary function tests if any 5. Chest Xray report if done 6. Laryngoscopy findings if any. Otherwise, she should be treated with: 1. A course of antibiotics 2. Mucolytics 3. Bronchodilators 4. Short acting beta agonists for few days 4. Followed up with long acting beta agonists and steroids Feel free to ask another query With regards
Follow-up: Child having difficulty in breathing and neck ultrasound is negative. What could be the problem? 20 minutes later
She has had 2 chest x rays both look good. when she coughs, she sometimes coughs up clear, runny mucus that sometimes looks thick. No fevers oh, also when she feels like she can't get her breath she will bend over
Answered by Dr. Prahlad Duggal 31 minutes later
Brief Answer: A through ENT and chest examination Detailed Answer: Thanks for the details. Please consult an ENT and get an anterior rhinoscopy and flexible laryngoscopy done. Please get a complete haemogram done in consultation with doctor to rule out an infective pathology which can present without fever also. A treatment mucolytics with bronchodilators, a combination or separately long acting beta agonists and corticosteroids should be given. Initial therapy should be supplemented with a short acting beta agonist which can be discontinued after few days. A mast cell stabilizer will also help in long term resolution of the problem though its role in short term relief of this episode will not be there. All these things can be discussed with the paediatrician/pulmonary medicine specialist or an ENT who is treating her. Steam inhalation, breathing exercises and avoidance of known allergens (if any) also help. Also the anxiety level of the child should be minimised by talking to her and reassuring her. Wish her good health. Regards