Martha Wills

I’ve been meaning to write a post about how I’ve learned to manage my daughter’s asthma, but as I’m not a doctor I’ve been hesitant.

That was until this morning when a friend posted a Facebook status update asking other moms for advice in regard to her sons’ asthma, and his first nebulizer treatment.

As someone who’s been dealing with this since April 2008, I thought now was the time to share my experience in the hope of helping her, and any other people struggling with such a diagnosis.

When my first-born twin (Sophie) was a little over a year and a half, a snotty virus (for which we’d already visited the doctor) turned into an afternoon of funny breathing.

It wasn’t major. She wasn’t on the floor gasping for breath.

But the fact that she was so little made it difficult to gauge the severity of the situation. Was she just stuffed up? Just tired?

By early evening I’d wondered enough, and a trip to the pediatrician led to a new reality.

Asthma became a fact in our lives.

By the time we arrived, the ladies at the front desk realized we needed help. They whisked us back, put Sophie’s little finger in an oximeter, which established she was breathing was at 60%.

We were sent straight to the hospital.

Since that day (and night) I’ve learned enough to write a book on how to manage the illness.

Because really, that’s all a mom can do. Manage. And learn.

Albuterol the wonder drug.

The first night in the hospital Sophie was given Albuterol through a nebulizer every four hours (if I recall correctly, she was given it a bit more often when we first arrived).

Albuterol is a wonder drug; a bronchodilator that opens up the airways of the lungs and is given two ways (either through a motorized nebulizer or the more commonly seen rescue inhaler).

I’ve had many conversations with my pediatrician and asthma specialist about the efficacy of the inhaler. According to medical folks, the inhaler is as effective as the nebulizer.

But to many moms who deal with their children’s asthma on a daily basis, there’s something about the constant inhalation of the Albuterol in the nebulizer that seems to work better than the two, minute-apart pumps from an inhaler.

The inhaler does have its place in our lives, though. Carried with us in backpacks, purses, and the car, we always have one ready in case a flare up occurs and the kid begins to cough. More about the cough later.

There is one side effect to Albuterol that must be mentioned.

Albuterol is known to increase heart rate, cause irritability and nervousness. In a child, the behaviors associated with these side effects are what I call “wildness”; extra tantrums, sometimes hitting.

I refer to my kid at this point as the Albuterol monster. She’s still cute, but a bear to handle.

Pulmacort, Flovent, and short course steroids.

Used in combination with Albuterol are steroids called Pulmacort (also known as budesonide), Flovent, and laundry list of other steroid choices administered in the nebulizer and/or inhaler.

Whenever Soph is having a big attack that calls for the use of then nebulizer, we add the Pulmacort up to twice a day.

Daily, we use the Flovent inhaler to keep the lungs open to inhibit the severity of the next attack.

There have been a few instances, however, when the use of the budesonide and Flovent haven’t been enough. In those cases, our pediatrician has prescribed an oral steroid.

Unlike the vaporized forms of these steroids that go directly to the lungs (avoiding the blood stream), oral steroids work by getting into the blood and then hitting the lungs.

There are serious side effects to the use of oral steroids and Sophie’s doctor and I avoid them as much as possible.

You may have heard of the term, “roid rage?” An increase in behavioral problems are one of the reasons that oral steroids are not as quickly prescribed.

Combine an Albuterol monster and a dose of oral steroids?

Hold your breath for the next 5-6 days. Your kid will feel better because they can breathe, but the inability to control emotions or sleep or hunger is really hard. Much harder on them than you.

Why’s your kid always sick?

This is a question I get a lot.

The truth is that my kid isn’t always sick, but when she does catch a virus her asthma always kicks things up a notch.

Having twins has helped me to see this more clearly.

Inevitably, as happens with little people, kids tend to catch each others’ illness. For her sister (Grace), a cold can come and go and she’s back to herself in due time.

For Sophie, the same illness lingers and sends us to the pediatrician to have a lung listen (we’ve been lucky that they’re almost always clear), and a few extra days of missed school.

A few weeks ago, after Grace had long passed the worst of the latest cold, Sophie was still struggling with post nasal drip, which led to lots of coughing.

The Albuterol and Pulmacort weren’t calming things down and I was having to administer the Albuterol more than every four hours during the night.

Needing Albuterol this much is a good clue that it’s time to get to the doctor.

Luckily Sophie’s lungs were clear, but she actually had a double ear infection (without a fever or any complaints).

Sure enough, treating the infection stopped the asthma.

The Cough. The Wheeze. The Chest Pull.

Many people say that they can tell their kids are having an asthma attack by the sound of their wheezing. For me, I can never hear it. I sometimes think I hear Sophie’s wheezing on the inhalation, but I’ve been told that asthma wheezing is more commonly heard on the exhale.

Because of my confusion I look for other signs of an attack.

For my daughter, next to the chest pull, her cough is the best indicator.

The asthma cough sounds wet, and unlike, a crouping, barking cough. Any cough that seems incessant is probably indicating a child’s difficulty breathing.

When Soph was younger and couldn’t verbalize her needs, I would listen for the cough and then administer her medicines.

Another good way to double-check the need for medicines is if the child’s upper chest is pulling in with each breath. And hard. If you aren’t sure, lift your kids shirt and have a look. A deeply inhaled pull at the chest (concave) is a sure sign that there is some difficulty with the breath.

Now that Sophie is older she can tell me if she thinks she needs her medicine, but often she’s so busy she doesn’t think about it, and I have to use my eyes and ears to decide when it’s time for a treatment.

How much medicine and when.

A kid who can’t breathe is an incredibly frightening situation for people who don’t deal with it daily, especially for caregivers, teachers, and moms who suddenly find themselves with an asthmatic child.

The best advice I ever got was this …

The Albuterol is not going to hurt her.

The directions for use say that Albuterol can safely be administered every 4-6 hours.

At school, if a kid has a prescription and they need the medicine, they should be given it without fear.

If they had a dose less than 4-6 hours before, but they need another to be able to breathe, caregivers musn’t be afraid to medicate according to the directions, and then get the kid to the doctor.

If your kid is given a dose in the middle of the night and needs another dose three hours later, you have to weigh the benefits.

I’ve called the night nurse and been told that despite having just finished a dosing three hours before, to give another dose since the coughing had not subsided, and then to call an ambulance. By the time the ambulance arrived, Sophie’s coughing was better, her breathing was not labored, and I was told that I’d done the right thing.

I called the pediatrician in the morning who reconfirmed that I hadn’t over-medicated my kid. In fact, she said I’d done exactly what she would have done.

This is a really important aspect to managing asthma. Of course you don’t want to over-medicate, but breathing is not an option, and using careful consideration when treating an asthmatic could be the answer to life or death.

In time you learn how to manage and make the best decisions based on the severity of the issue at hand.

*Writing that just caused super anxiety. I’m not a doctor, remember? I’m not telling you to over-medicate your kid. Did I mention I’m not a doctor?

Triggers.

As I mentioned at the beginning, it often seems like the asthmatic child is more sick than the average boy or girl. For my daughter, there are triggers that cause an attack.

For us, the common cold or virus always causes Sophie’s asthma to become problematic.

But other triggers, like seasonal allergies, animal fur, tobacco smoke, and mold can cause bronchial restriction, too.

We chose to test Soph for allergies and found that she’s allergic to trees and flowers of all kinds. This makes it tough for us as seasons change over. Spring and fall are beautiful to look at, but I literally lose sleep as I’m up in the night (did you know asthma is worse at night?) filling the nebulizer in the dark.

Prescription Singulair once a day seems to have helped.

Exercise induced asthma?

Many parents have children with no signs of asthma until (during) or after physical excursion.

While this isn’t the main issue for us, I have noticed that a lot of exursion at the beginning or tail end of a cold or virus can exacerbate Sophie’s asthmatic episodes.

Just another reason to have an inhaler with you at all times.

How to manage the meds.

With so many medications it can be hard to keep track of everything. For me, having everything in one place has been the only way to make sure I’m on top of things in this department.

There’s nothing worse than watching your kid coughing and hacking while you’re trying to locate the meds.

Using a basket (we call ours “the blue basket”), I have everything I need to treat an episode.

The nebulizer is there and waiting. The Albuterol and Pulmacort are in the labeled boxes they came in, and I check them regularly to determine if we need to restock. There is an inhaler in the box, because some nights a cough can be treated without the nebulizer (first line of defense). The Singulair is in the basket, as is a temporal thermometer (somehow we lose thermometers often, so I now know where I can always find one).

Since the girls’ dad and I are separated, the blue basket travels back and forth. This way, I”m sure that the medicines are always available and I don’t have to worry if dad has been able to keep on top of refills. etc.

Recently I ordered a second nebulizer so that we each could have one. It lessens the load, so to speak.

Nebulizers do wear out in 4-5 years (so they say), so I need to pick up another one soon.

Overall, we are managing really well.

The last few illnesses did require treatment for the asthma, but we haven’t ended up in the hospital and Sophie’s oxygen level is never below 97% (which is great).

For moms who are just beginning the journey, know that you will have many sleepless nights. Your job is to not only care for your child, but educate others so that they understand the illness without fear.

Keep in mind, too, that there is always the hope that your child will grow out if their asthma.

Many, many  do!

M.

Do you or your child have asthma? Anything I’ve forgotten?