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Suggest treatment for asthma exacerbation

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Posted on Wed, 13 May 2015
Question: Hi my daughter is suffering from cough dry cough for a week now, she was prescribed nebulization with Duolin 5 times a day for two days, but couldn't see any improvement, rather it worsened. This morning she was nebuliser with Leolin and seems have some relief. Coughs are not going by any means.
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Answered by Dr. Sumanth Amperayani (27 minutes later)
Brief Answer:
Looks like asthma exacerbation

Detailed Answer:
.Hi...Thank you for consulting in Health Care magic. Greetings from XXXXXXX
By what you quote I feel what your kid could be having viral associated wheeze or multi triggered wheeze or asthma exacerbation. I have a few questions for you -
Questions:
1. How many days per month does she cough or feel breathless?
2. How many nights per month does her sleep get disturbed due to above symptoms?
3. Does she feel breathless when she runs around or plays with other kids?
4. Are the symptoms when there are seasonal changes?
5. Is there any family history of asthma or any other sort of allergies like skin allergy etc.?
6. Is the cough always associated with fever?

Kindly get back to me with answers and I will be glad to guide you further.

Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.
Dr. Sumanth MBBS., DCH., DNB (Paed).
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Sumanth Amperayani (17 minutes later)
Thank you Dr. Samanth,

Pl find below answers...
1. Not regularly, 2 to 3 days in between,
2. Not normally, only for last 4-5 days in between, but for last two nights continuously
3. I saw her taking a long breath when she does physical activity too long,
4. Yes, every season change she gets cough and running nose, but change from winter to summer is worst, she end up to long lasting dry cough. But this time it is worse. When we visited dr. She had short dry coughs, dr advised nebulization, we did that at home bought a nebuliser as it needed 5 times a day for sat and Sunday. First dose helped, but after second dose cough increased. We tried coscopin, home remedies but no solution. She kept herself busy in games, that helped for like 30 mins breaks in between. Last night we didn't sleep. Morning prescription was Leolin, we nebulised, now she is sleeping for about one hour.
5. No family history of asthma, though both of parents are prone to seasonal cold and morning sneezes daily :)
6. There is no fever , but when she was less than 5 year, she always had cold with fever in season changes, almost every alternate month sort of.

I hope I answered properly. One more input, she was in a Air conditioned school till last year, small school. Now is admitted in a good bigger school with normal facilities, no AC. And it's wheat cutting season in XXXXXXX which is prone to allergies.

Regards, XXXXXXX Bisht
doctor
Answered by Dr. Sumanth Amperayani (1 hour later)
Brief Answer:
Management suggested

Detailed Answer:
Hi....By what you quote I feel what your kid is having is asthma. Please don't feel that I am being blunt, but rather than using frequent steroids it is better to have a label and follow up with simpler alternatives than using steroids which are associated with complications.

Suggestions:
1. There are certainly alternative management therapies in allopathy now-a-days. Medicine has advanced a lot and not asthma is 100% controllable.
2. Inhalers are the newest management strategies for this. If I were your paediatrician I would have suggested the use of Foracort metered dose inhaler (100mcg) 2 puffs twice a day through a spacer and this is for regular use for 8 weeks. Another metered dose inhaler is Levolin and this can used as rescue therapy whenever the kid is having severe cough in spite of regular usage of Budecort. The technique is very important and very crucial for the drug to be delivered correctly to the lungs. Regularity of medicine usage also matters a lot. So do not discontinue abruptly after you notice some improvement. The technique of administering an inhaler using a spacer has to be taught to you by your doctor and these are prescription medicines. So I suggest you consult your paediatrician for this.
3. Triggers can be environmental changes/ dust/ talcum powder/ seasonal changes/ un-cleaned a/c vents/ cold weather etc....we can specifically say this is the cause - unless we observe the kid closely - best person is the parent.
Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.
Dr. Sumanth MBBS., DCH., DNB (Paed).
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Sumanth Amperayani (19 minutes later)
Thanks a lot Dr. Just a last input. She has been put on Combihale inhaler (format enrol fulmar ate and budges onside powder 6mcg + 200 mcg) for six months last year along with Montetop l (montelukast & levocetirizine tabs) one daily .

I guess after an immediate therapy we need to put her on same again.
Dr wasn't available on weekends, so I will take her to him today ASAP.

Thanks a lot , awaiting response.
Regards, XXXXXXX Bisht
doctor
Answered by Dr. Sumanth Amperayani (1 hour later)
Brief Answer:
I suggest metered dose inhaler rather than dry pow

Detailed Answer:
Hi....as an immediate treatment I suggest -

1. Oral Prednisolone at 1mg/ kg/day in 3 divided doses for 3 days.
2. Rather than dry powder inhalers I suggest you shift over to metered dose inhalers.
Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Sumanth Amperayani

Pediatrician, Pulmonology

Practicing since :2003

Answered : 8347 Questions

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Suggest treatment for asthma exacerbation

Brief Answer: Looks like asthma exacerbation Detailed Answer: .Hi...Thank you for consulting in Health Care magic. Greetings from XXXXXXX By what you quote I feel what your kid could be having viral associated wheeze or multi triggered wheeze or asthma exacerbation. I have a few questions for you - Questions: 1. How many days per month does she cough or feel breathless? 2. How many nights per month does her sleep get disturbed due to above symptoms? 3. Does she feel breathless when she runs around or plays with other kids? 4. Are the symptoms when there are seasonal changes? 5. Is there any family history of asthma or any other sort of allergies like skin allergy etc.? 6. Is the cough always associated with fever? Kindly get back to me with answers and I will be glad to guide you further. Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health. Dr. Sumanth MBBS., DCH., DNB (Paed).