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Suffers from mild persistent asthma and also allerggic rhinitis. Added pentids400 and fluticasone pripionate nasal spray. Help?

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Question
Sir,
My 4yr old son suffers from mild persistent asthma and also allerggic rhinitis.he s been on montek lc kid,budesonide inhaler for 6Months n has been episode free since 7months so far.but doctor also added pentids400 n fluticasone pripionate nasal spray 2months back and my son s voice has become very very hoarse since then and his voice is only getting worser. We r really worried if his vocal cord s damaged forever because of possible side effects of longterm inhaled corticosteroids n prolonged antibiotic therapy.Is this cibdition reversible plz kindly help as we are very very worried.Thank you very much in advance.
Posted Thu, 24 Oct 2013 in Asthma and Allergy
 
 
Answered by Dr. Sumit Bhatti 17 minutes later
Brief Answer:
Rule out Adenoid hypertrophy. Laryngoscopy.

Detailed Answer:
Hi,

Thank you for your query.

1. Get an X-ray Skull lateral view for Adenoids done. This would be the most common cause for these symptoms at his age, followed by nasl obstruction.

2. Any side effects of his current treatment will be reversible, there is no cause for worry.

3. A laryngoscopy may be required if there is no improvement or worsening in his voice. This is easy in an adult, but may require anesthesia in a child. Direct examination of the throat and larynx help diagnose the exact problem. If you wish to avoid anesthesia, try a flexible nasopharyngoscopy or a high frequency ultrasound (USG) of the larynx.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffers from mild persistent asthma and also allerggic rhinitis. Added pentids400 and fluticasone pripionate nasal spray. Help? 38 minutes later
Thank you very much Doctor for your reply.it gave us so much relief to hear its reversible.Sir X-ray skull lateral view for Adenoids has been done and his Paediatrician said its just slight enlargement of adenoids and hence no surgery is required.Also his peak IgE level during severe wheeze n nasal allergy was only 133.0 IU/ml. Sir,wud you advice stopping inhaled corticosteroids till his voice is normal or larryngoscopy at this juncture.Wud there be any treatment for voice reversal again or not necessary. thank you very much for your response doctor.
 
 
Answered by Dr. Sumit Bhatti 26 minutes later
Brief Answer:
Discontinue the steroid spray and observe.

Detailed Answer:
Hi,

Thank you for writing back.

1. You may discontinue the steroid nasal spray and observe any change in his voice.

2. Anti allergic medications also tend to dry the throat. Adding a mucolytic may help. Does he snore or have mouth breathing?

3. Laryngoscopy may be deferred to a later date. If there is no improvement or if there is any worsening of his voice, it may be done.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffers from mild persistent asthma and also allerggic rhinitis. Added pentids400 and fluticasone pripionate nasal spray. Help? 47 minutes later
Hello Doctor,
Thank you very much once again for your time and response. He breathes very normally doesn't snore or mouth breathe also his allergic rhinitis seem to be under control lately.

1.Will discotinuing steroid nasal spray again trigger his allergic response to pollution or is IT likely that its completely cured of allergic rhinitis?

2.Also is IT advisable to stop budesonide inhaler treatment completely as he has completed The prescribed usage of 6months preventive medicine treatment?

3.has this inhaler therapy rendered him immune to wheeze attacks or After The treatment stops wud he be still susceptible to wheezing attacks assuming he is kept in a trigger free environmnt?

Thank you very much Doctor for your valuable response

Sir, IT would be greatly helpful if you could plz kindly answer our last query as we are quite anxious about the long term effects of those drugs on our little son's Health.

Thanking you very much in advance,

Regards
 
 
Answered by Dr. Sumit Bhatti 11 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Long term nasal steroids helps lower the allergy response. There is no cure for allergy, however with sustained treatment, it can be controlled.

2. You should let your Pediatrician or Chest Physician decide about the budesonide inhaler. if he is weaned off the inhaler, keep it ready for any future attack.

3. If he is in a trigger free environment, he may be able to sustain. However the true test will be if he is exposed to the allergens or pollution.

4. You may follow up with his report on the hoarse voice directly at bit.ly/Dr-Sumit-Bhatti

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffers from mild persistent asthma and also allerggic rhinitis. Added pentids400 and fluticasone pripionate nasal spray. Help? 9 hours later
Doctor, On yesterday S paed visit,his paed said his hoarseness is due to laryngitis n prescribed cefadroxil 250mg and prednisolone5mg for 5 Days. After 5days regular usage of pentids400 and budecort100 inhaler till January n even more. Discontinue montek lc n nasalspray.Also he said my son was wheezing too though I cudnt see external ly his breathing difficulty. He advised his tonsils n adenoids have become very enlarged since April s XRay n no improvement inspire of treatment.he advised surgery of tonsils n adenoids in january to further check if he fails to respond. My son has difficulty swallowing food since yesyerday too.

1. Sir, v wud be moving to north UK in April.is IT advisable to keep him Home than school as his classroom s airconditioned as well as their irresponsible use of goodnight liquid vapriser throughout d day. I feel this vapouriser chemical in coninuos ac is aggravating his situation. He status fine at Home during holiday S but just fewdays of school n he has his airwarys irritated. Plz suggest Sir if we cud keep him Home till v leave to northern part of Uk (extreme cold weathrr)so that he at least stays healthy till v leave.

2.Also doctor,plz advise if surgical removal of those tissue S is really needed .will surgery make him more prone to upper respiratry infections. Also my son S weight has no change for past 2 Months 13 kgs since august. He s very short too for 4yrs.

3.Sir.is laryngitis XXXXXXX wat Food wud aid in his weight gain? I give him fish all vegetables n sprouts n egg S but astonishing as no gain in weight or height no growth too. Plz advise doctor.

Sir plz kind ly address our school concern for good Health as a nearing abroad journey to colder country is imminent. And hence surgery advised or not

thank u very very much doctor in advance.
regards


 
 
Answered by Dr. Sumit Bhatti 14 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Your doctor may decide about surgery as per the response to medication and on direct examination.

2. It is not advisable to keep him out of school. Excessive hygiene may also hamper the development of immunity.

3. Adenoids may be operated, however tonsil removal is usually planned after the age of 5 years, unless the problem is severe.

4. Adenoid hypertrophy commonly causes failure to thrive as the child does not eat well.

5. Laryngitis must not be ignored. It must be investigated and treated.

6. Coablation is a newer technology. After rhe removal of the tonsils and adenoids, the child eats, breathes, grows well.

I hope that I have answered your query. If you have ant further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffers from mild persistent asthma and also allerggic rhinitis. Added pentids400 and fluticasone pripionate nasal spray. Help? 10 hours later
Greetings!

Thank you very much fir your valuable advice.

1.Doctor, is continuous 7 hour air-conditioning OK for our asthmatic son in school? (With goodnite mosquito vaporiser)

2.Also besides school he has 3 hours/week Karate plus 2hours/week abacus outside environment exposure unlike a complete house arrest.So considering his outside exposure can we keep him away only from his air-conditioning class rooms for six months.

Thank you very much Sir for understanding our concern.
Regard S.
 
 
Answered by Dr. Sumit Bhatti 34 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Continuous air-conditioning and use of mosquito-repellant vaporizers may worsen the asthma. Avoiding this for a few days (not for six months) will help understand the impact of these conditions on his asthma.

2. His exercise and outings may be beneficial to him and should be continued. Extra emphasis on hygiene may increase the tendency to allergies and asthma.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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