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Suggest treatment for recurrent cold during winters

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Posted on Fri, 20 May 2016
Question: My son has recurrent colds throughout winter(oct-feb, he is fine in the summer & the rest of the year)..his recent x-ray showed he has perihilar peribronchial thickening.He is 4 years old. He had bronchiolitis when he was 7months old. I am just worried..this time he had cold, I just looked inside his nose and his right nostril is fully blocked to the extent that no air can pass (his inferior turbinates are fully swollen)...using nasacort nasal spray but it isn't effective..Iam very concerned, couldn't get an ENT appointment until next month.Please help
doctor
Answered by Dr. Kaushal Bhavsar (34 minutes later)
Brief Answer:
Possibility of allergic rhinitis (seasonal) is more.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
By your history and description, possibility of allergic rhinitis (seasonal) is more in his case.
Nasacort is having only steroid.
In allergic rhinitis, combination of intranasal steroid and antihistamine (azalastine) is beneficial.
Oral combination of antihistamine (levocetrizine or fexofenadine) and anti allergic (montelukast) during those months (October to February) is also advisable.
Influenza vaccination annually is also helpful on prevention of such symptoms.
So please let me know
1. Is he vaccinated with Influenza vaccine?
2. How much times in a day you are giving Nasacort?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (3 days later)
Thank u for your answer.
1.Yes he gets his annual flu shot.
2.I give him 1 spray in each nostril once a day as he is only 3.5 yrs old.

Can u please elaborate on Perihilar Peribronchial thickening? Is that reversible? Does that really suggest of mild persistent asthma? Will it go away on its own?

Can u give Singulair & other anti-histamine as a combination?

His swelling inside the nose has subsided now.

Just want to have a right action plan before next winter starts...what do u suggest?

One last question I have is do the albuterol puffs or nebuliser usage regularly makes it habit forming? Which one is better to use for cough-nebuliser or spacer with MDI?
doctor
Answered by Dr. Kaushal Bhavsar (11 hours later)
Brief Answer:
Spacer with MDI is better than nebulizer.

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.

Answer to your 1st question.

Yes, his x ray changes are mostly due to uncontrolled asthma. So better to start treatment for asthma. Once his asthma is controlled, his chest x ray will be normal. So it will not go away by its own, you need to first control his asthma.

Answer to your 2nd question.

Yes, you can give singular ( montelukast) and antihistamine (levocetrizine or fexofenadine) as a combination. Infact, combination is easily available in the market because these drugs are beneficial when giving togather.

Answer to your 3rd question.

Right action for him is start treatment 1 week before starting winter and continue till winter ends.

Answer to your 3 rd question.

No, it is not habit forming. Inhaled treatment is the best treatment for asthma. It is having less side effects and more benefits. So inhaled treatment is best for asthma.

Answer to your 4th question.

MDI with spacer is equally effective as nebulizer. But it is easier to use MDI as compare to nebulizer.

Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wishing good health to your son. Thanks.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (31 hours later)
Thank you so much for the detailed answers Dr XXXXXXX

I have now uploaded my son's chest x-ray which was taken a month ago, can you please take a look at it and let me know your opinion. He had one taken in Dec 2015 which was clear (don't have a copy of it to upload). Also, this time I am writing in detail about my son's visits to the doctor.

I go to a regular Pediatrician and upon her advice I got my son seen by both a Pediatric Pulmonologist and also to an Allergy Specialist.

The Pulmonologist took the x-ray I uploaded and as discussed earlier suggested that he might have mild persistent asthma. She gave me an action plan which suggested usage of Flovent 44mcg 2 puffs twice a day for 2 months and the rescue inhaler Albulterol every 4 hrs as needed. Since I saw her, my son didn't have bad cough or wasn't wheezing so I just used albuterol as and when needed.

After that I went to an allergy specialist who did a skin prick test and suggested my son had allergic rhinitis like u mentioned and said he has mild sensitivity to cat, dog and dust. He advised nasal sprays and when my son has very bad coughs to use Q-var puffs.

After these two visits, I saw his regular pediatrician to get a correct action plan and by this time he came up with a new cold with mostly upper congestion in his nose which is always the case. So this time, she suggested to go check with an ENT for which I didn't get an appointment until next month.

His condition improved since usage of nasal spray with singulair and fexofenadine combination.

After reading your response last night, I was confused again. After reading the side effects of Flovent and in between doctors visits, I never bought it and made my son take it's puffs.

Since it is a month since that x-ray was taken and my son has only mild cold now no cough...do u still suggest me to start the Flovent now or should I wait for him to be seen by an ENT and then take a proper action plan with his regular Pediatrician's help?

Please advise. Also, my son is a very picky eater, to see him suffer with these colds and take lot of medications makes me feel helpless. Appreciate any advise on it too.

Thank you so much for your time and valuable input. Look forward to hearing from you.

doctor
Answered by Dr. Kaushal Bhavsar (2 hours later)
Brief Answer:
Do you have any pets at home?

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
I have gone through the chest x ray, you have attached.
His chest x ray is rotated. He might be crying or apprehensive while doing chest x ray. Is it so?
And best treatment for allergic disease is identification of allergen and if possible complete avoidance of it.
Since he is allergic to cat, dog and dust, better to avoid all these stuff.
Please let me know if you are having pets at home.
And in my opinion, since he is improving with nasal spray and oral combination, no need give inhalers.
Please let me know
1. Was he agitated while doing chest x ray?
2. Do you have pets like cat or dog at home?
3. Are you having dusty atmosphere at or around home?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (5 hours later)
1. I am not sure about the X-ray as only his dad was allowed in the x-ray with him & he thinks he might have moved while taking the x-ray. Usually he is very scared of the x-ray but this one they took with him standing & not lying down so he didn't cry buy might have moved.
2. We have no pets at home, I mentioned this in my earlier posts so didn't include that detail again.
3. We live in carpeted apartment & I tend to keep everything dust free & vaccum regularly. Since we live in US, we have heaters running in winter & there is lint accumulated around the vents.

doctor
Answered by Dr. Kaushal Bhavsar (46 minutes later)
Brief Answer:
Continue nasal spray and oral combination.

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
So, there is no chance of allergen exposure.
Hence, continue nasal spray and oral combination of antihistamine and anti allergic drugs.
Consult ENT doctor and get done clinical examination of nose.
He is mostly having allergic rhinitis. And drugs he is taking are appropriate for the disease.
ENT consultation is required to confirm the diagnosis and rule out other causes.
I also advice you to start nasal spray and oral combination 1 week prior two winter and continue till winter lasts.
Don't worry, he will be alright.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer. I would love too hear your son's progress.
You can ask me directly on bit.ly/askdrkaushalbhavsar. Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Kaushal Bhavsar

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Suggest treatment for recurrent cold during winters

Brief Answer: Possibility of allergic rhinitis (seasonal) is more. Detailed Answer: Thanks for your question on Health Care Magic. I can understand your concern. By your history and description, possibility of allergic rhinitis (seasonal) is more in his case. Nasacort is having only steroid. In allergic rhinitis, combination of intranasal steroid and antihistamine (azalastine) is beneficial. Oral combination of antihistamine (levocetrizine or fexofenadine) and anti allergic (montelukast) during those months (October to February) is also advisable. Influenza vaccination annually is also helpful on prevention of such symptoms. So please let me know 1. Is he vaccinated with Influenza vaccine? 2. How much times in a day you are giving Nasacort? Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your son. Thanks.