CT scan for asthma -- should I resist?

[Dov'sMom]

My 3.5 yo son has asthma that we are working to control. Right now he's on quite a bit of maintenance medication (Singulair, plus two 110 puffs of Flovent twice a day) and he still has an attack, averaging about a week, every 6-8 weeks.

His attacks usually start with a head cold -- sniffling and sneezing -- that progresses to breathing issues.

His doctor says every 6-8 weeks is too frequent for a child his age to be having colds and wants to do a CT scan to see if there's infection somewhere in his sinuses that's triggering the colds that are triggering the asthma.

So I have a couple of reservations. First, every 6 weeks or so doesn't seem unreasonable to me for having a cold. Especially since he's usuallly not the only one in the family with a cold; he's just the only one with asthma because of it. Second, a CT scan is a huge dose of radiation. What's the benefit? I'd rather give him prophylactic antibiotics than the scan, I think. Is there any other treatment for persistent sinus infection?

[kittynurse]

My son has viral-induced asthma so I feel your pain. It's so awful to see our little ones struggling to breathe.

While I agree that a cold every 6 weeks isn't overly unusual I think that your dr.'s point is that considering how much medication your son is on, he is very poorly controlled if he is still having full blown asthma episodes with every cold.

We've never done a CT scan so I can't advise you on that. Have you investigated allergies? Our son's asthma came under much better control once we identified his allergens and worked to remove them from his environment. He is now controlled to the point that he can usually handle a cold without having more than a few wheezes. Of course, we still start up his blue puffer at any sign of a cold.

HTH

Martha

[Violet2]

I guess I would want to know what the CT scan would prove and how it would change his care? Would he get a better antibiotic? If so,why not let him try that w/o the scan--that's probably better for him. BTW I agree that's a lot of radiation.

If you think the sinuses are involved, try a neti pot with a saline solution. That works well for a lot of people.

I have viral induced asthma and I don't get sick every 6 weeks. So I do think that's a lot. I would look at boosting his immune system with D3, zinc and C.

V

[kittynurse]

Originally Posted by Violet2

I have viral induced asthma and I don't get sick every 6 weeks. So I do think that's a lot. I would look at boosting his immune system with D3, zinc and C.

V

You know, I've been thinking about this since I posted and I have to say I agree. We might have some rough patches in the winter but when I think about it, every 6 weeks does seem frequent if it is all year long.

Martha

[Dov'sMom]

Originally Posted by kittynurse

My son has viral-induced asthma so I feel your pain. It's so awful to see our little ones struggling to breathe.

While I agree that a cold every 6 weeks isn't overly unusual I think that your dr.'s point is that considering how much medication your son is on, he is very poorly controlled if he is still having full blown asthma episodes with every cold.

We've never done a CT scan so I can't advise you on that. Have you investigated allergies? Our son's asthma came under much better control once we identified his allergens and worked to remove them from his environment. He is now controlled to the point that he can usually handle a cold without having more than a few wheezes. Of course, we still start up his blue puffer at any sign of a cold.

HTH

Martha

Thank you for your perspective.

We did allergy tests when he was 2, before he started having asthma issues, and the results were negative for anything. We did them again at close to 3 when he had some major breathing trouble (the start of his asthma) and he was completely negative except maybe for an inconclusive result with respect to grass.

They drew blood to redo the allergy tests yet again, and will only do a CT scan if nothing new pops up.

[Dov'sMom]

Originally Posted by kittynurse

You know, I've been thinking about this since I posted and I have to say I agree. We might have some rough patches in the winter but when I think about it, every 6 weeks does seem frequent if it is all year long.

Martha

I don't know that it's reallya ccurate to say every 6 weeks all year long.

The first time we heard of Albuterol was last May when he had a collosal attack, probably because we didn't identify early signs. From May to July he was having regular problems, but he was also on barely any maintenance medication -- it was a catch-up game. In September, the doc took him off all maintenance meds, and he had a bad attack in October. He was put back on Singulair then and had another bad attack in December. Then he was put on one Flovent puff a day. He had another attack in March, and the doctor upped the Flovent to one puff twice a day, and another attack in May, when the Flovent was doubled again. His last asthma attack was last week, but he never wheezed audibly -- his peak flows dropped maybe 30%. (As opposed to 50% in May.)

[kittynurse]

Originally Posted by Dov'sMom

Thank you for your perspective.

We did allergy tests when he was 2, before he started having asthma issues, and the results were negative for anything. We did them again at close to 3 when he had some major breathing trouble (the start of his asthma) and he was completely negative except maybe for an inconclusive result with respect to grass.

They drew blood to redo the allergy tests yet again, and will only do a CT scan if nothing new pops up.

Has he had any skin testing for allergies? It's my understanding that the skin test is more reliable with less false negatives. Sorry to keep harping on allergies but we found that reducing the inflammation in our son's lungs that was caused by allergies dramatically improved his ability to handle viruses and I've become a bit passionate about it!

Martha

[Dov'sMom]

Originally Posted by Violet2

I guess I would want to know what the CT scan would prove and how it would change his care? Would he get a better antibiotic? If so,why not let him try that w/o the scan--that's probably better for him. BTW I agree that's a lot of radiation.

If you think the sinuses are involved, try a neti pot with a saline solution. That works well for a lot of people.

I have viral induced asthma and I don't get sick every 6 weeks. So I do think that's a lot. I would look at boosting his immune system with D3, zinc and C.

V

I'm going to ahve to get a better answer from the doctor about the benefit from the CT scan.

Neti pot is a good idea, since we do know he's often congested. The reason we did the allergy tests back last winter, before he started having asthma problems, is that he had a chronic runny nose (whcih, incidentally, dried up once he went on Singulair).

[kittynurse]

Originally Posted by Dov'sMom

I don't know that it's reallya ccurate to say every 6 weeks all year long.

The first time we heard of Albuterol was last May when he had a collosal attack, probably because we didn't identify early signs. From May to July he was having regular problems, but he was also on barely any maintenance medication -- it was a catch-up game. In September, the doc took him off all maintenance meds, and he had a bad attack in October. He was put back on Singulair then and had another bad attack in December. Then he was put on one Flovent puff a day. He had another attack in March, and the doctor upped the Flovent to one puff twice a day, and another attack in May, when the Flovent was doubled again. His last asthma attack was last week, but he never wheezed audibly -- his peak flows dropped maybe 30%. (As opposed to 50% in May.)

My apologies, it sounds like you are still in the "getting it under control" phase. My guy had his first episode at 10 months so I falsely assumed that your little guy had been on the meds for a similar amount of time.

It takes awhile to get things stable. It's good that your dr. is investigating root causes. Ours didn't really, the allergy thing was discovered as an aside from a reaction to egg that he had.

Sorry also for taking your thread off track!!! Hopefully more people will have perspective on the CT scan.

Martha

[Dov'sMom]

Originally Posted by kittynurse

Has he had any skin testing for allergies? It's my understanding that the skin test is more reliable with less false negatives. Sorry to keep harping on allergies but we found that reducing the inflammation in our son's lungs that was caused by allergies dramatically improved his ability to handle viruses and I've become a bit passionate about it!

Martha

The first test was skin testing and the little rows of bumps were picture perfect. Nothing at all. He was pretty young for allergy tests, though, so it can't hurt to do it again. (Well, except insofar as it hurts literally speaking, but I'll take that hand's down over massive radiation doses.)

[kittynurse]

Originally Posted by Dov'sMom

I'm going to ahve to get a better answer from the doctor about the benefit from the CT scan.

Neti pot is a good idea, since we do know he's often congested. The reason we did the allergy tests back last winter, before he started having asthma problems, is that he had a chronic runny nose (whcih, incidentally, dried up once he went on Singulair).

Last post about allergies I swear!!! Singulair is also used as an allergy medication so it is possible that the chronic runny nose is from allergies. What colour is the mucus? Clear, runny discharge tends to be allergies.

Martha

[Dov'sMom]

Originally Posted by kittynurse

My apologies, it sounds like you are still in the "getting it under control" phase. My guy had his first episode at 10 months so I falsely assumed that your little guy had been on the meds for a similar amount of time.

It takes awhile to get things stable. It's good that your dr. is investigating root causes. Ours didn't really, the allergy thing was discovered as an aside from a reaction to egg that he had.

Sorry also for taking your thread off track!!! Hopefully more people will have perspective on the CT scan.

Martha

Not at all. As you can see, I'm still trying to get my head around the asthma generally and I really appreciate your and Violet's input on the general picture.

[Violet2]

Also, make sure you see a pulmonologist. Sounds like you're working with someone who comes at this from the sinus/ allergy paradigm which I NEVER found helpful.

My asthma goes to pot anytime I'm working with a doc whose all hyped about sinusitis or allergies--they don't properly medicate the asthma and I get sick.

So I would get into a ped. pulmo if you haven't already.

V

[Dov'sMom]

Originally Posted by kittynurse

Last post about allergies I swear!!! Singulair is also used as an allergy medication so it is possible that the chronic runny nose is from allergies. What colour is the mucus? Clear, runny discharge tends to be allergies.

Martha

I know. I took it as confirmation that he had allergies when the runny nose dried up, but all the tests have been negative. The truth is, his pediatrician said he was probably allergic back when he was 9 months old.

The mucus is often clear, but frequently solid white and or colorful. THe constant drip that's mostly gone was clear.

[Dov'sMom]

Originally Posted by Violet2

Also, make sure you see a pulmonologist. Sounds like you're working with someone who comes at this from the sinus/ allergy paradigm which I NEVER found helpful.

My asthma goes to pot anytime I'm working with a doc whose all hyped about sinusitis or allergies--they don't properly medicate the asthma and I get sick.

So I would get into a ped. pulmo if you haven't already.

V

Should the fact that his asthma doctor's office is called "Center for Asthma and Allergy" be an alert that she's going to focus on that element?

I really like and trust our pediatrician. I have an appointment with her tomorrow for another child and will raise the idea of seeing a different asthma specialist.

[kittynurse]

Originally Posted by Violet2

Also, make sure you see a pulmonologist. Sounds like you're working with someone who comes at this from the sinus/ allergy paradigm which I NEVER found helpful.

My asthma goes to pot anytime I'm working with a doc whose all hyped about sinusitis or allergies--they don't properly medicate the asthma and I get sick.

So I would get into a ped. pulmo if you haven't already.

V

I agree. Although it would seem from my (numerous!) posts that I think allergy is *the* answer to asthma, I actually think it is good to approach it from a more broad angle because asthma has so many root causes.

We haven't seen a pulmonologist because allergies ended up being the answer for our son but if we hadn't seen such a huge improvement we would have pushed for more investigation.

Martha