Safety of salbutamol (ventolin) for todler

[DevaMajka]

I'm wondering what your thoughts are on salbutamol puffers for toddlers. We've been told to give ds2, 17mo, salbutamol "every 4-6hrs prn" for 5 days, every time he starts a cold, gets a runny nose, etc.
I hate to give him meds if he doesn't need it, but OTOH I'd rather give it to him than have him end up in the hospital again.

background:
In the beginning of Nov, he was hospitalized for 2 days with labored breathing. He started having a runny nose the day prior. His oxygen levels were low- mid 80's, until they put him on oxygen. He tested negative for all the viruses they tested for.
The end of Nov, the same thing happened- he had a runny nose, the next day his breathing got progressively worse. Oxygen levels were mid/upper 80's. In hosp for 2 nights.
Both times, he didn't really respond much to the first 2 nebulizer treatments, but responded really well to all the subsequent treatments. They told us to use the puffer for 5 days, and he responded well to the treatments at home.

So he's better now. But now I don't know how I feel about giving him the puffer every time he gets a runny nose. Opinions?

[stik]

Those were some scary O2 levels. 

My dd gets prophylactic nebulizer treatments all winter long because of her asthma.  (I'm jealous of your puffer, our pediatrician says Hattie's too young for one.)  When she's sick, she also gets rescue medication at least three times a day - we have been told not to hesitate to do more if she seems to be having difficulty.  There are a lot of times when I can let myself think the daily treatments aren't really needed.  She's really healthy most of the time.  But she has a history of pneumonia, and when she starts to sniffle there's a decent chance that she's about to be seriously ill.  Breathing treatments every 4-6 hours during illness are a very common recommendation for toddlers with asthma.  With 2 hospitalizations in a month, I'm surprised that's all your son has been prescribed. 

Anyway, I wouldn't hesitate to administer rescue medication 4-6 times daily during an illness, even if the illness appears minor. 

[DevaMajka]

Originally Posted by stik 

Those were some scary O2 levels

yes, the first time we went in, we actually went to a walk in clinic. The doctor took his levels, and just about panicked! She called 2 ambulances, and perhaps even a helicopter. She was freaked out! Luckily, his levels improved tremendously after about 5 seconds on oxygen. They kept going down the minute they took him off oxygen, but as long as he was on oxygen, he was totally stable.

[stik]

I am LOL at two ambulances for one baby!  I'm glad the O2 worked. 

[DevaMajka]

Sorry I was short before. I was trying to eat falafels and type at the same time. lol.

I guess I'm just in denial about it, that it won't happen again. I suppose you're right- twice in one month probably means it could likely happen again.

So would you use the puffer every 4-6 hours from the start of a cold, or would you wait for a sign of breathing symptoms? Dp is leaning toward using it a few times a day from the first sign of a cold. He may be right. I just have it so ingrained in me to worry about medicine, kwim? I guess I never realized before how freakin' scary it is to have a kid who can't breathe properly.

[tylerdylan]

My DS (5.5) has had asthma since he was 11 months old.  He is on Ventilin as needed and Flovent (which is a steroid inhaler) twice a day.  We see a Respirologist at our children's hospital for it.  We have been assured that the Ventilin is very safe.  Sometimes we have to give him up to 20 puffs of it to get rid of a bad attack. They said this is fine because you can't OD on ventilin.  The Flovent I am not thrilled about using daily, but without it his asthma is out of control and he has several attacks a day which is scary. 

When my other DS (3) gets a chest cold he gets wheezy and can't seem to catch his breath.  I don't hesitate to give him his older brother's ventilin.  It makes a world of difference for him.  In the absence of a cold he has no issues with asthma.

IMO Ventilin beats a trip to the hospital hands down!

[Peony]

From the first sign of a cold. We've done that for year with DD2, if you wait until she is experiencing breathing issues then it is too late, you will be trying to play catch up. You need to get a head start on it by starting it at the first sign of illness. They are probably assuming some viral induced airway issues right now, which he could certainly grow out of. 

[coyotemist]

FYI, I'm a respiratory therapist, this is what I do, so my opinion may be colored by this fact...

Breathing is the most important task the body does.  Most of the time if kid's hearts fail, it's because their lungs weren't working right, you fix the lungs, you can often fix the rest (adults are different).  Not that your son's heart is going to fail...but you should know that info.

Ventolin is perfectly safe, however, it's just a quick fix, not the long term fix.  I recommend you pull in additional resources if you can.  Get a pulmonologist, get on a controller or two (my daughter has moderate to severe asthma at 12, she takes Advair, Singulair, Ventolin, plus some alternative meds).  Don't be afraid of short bursts of steroids with his lung history, it might be necessary until you get the controllers working well.  Advair isn't appropriate for a 2 year old, but flovent or Qvar would be.  Do you have a spacer with a mask?

Invest in a cheap stethescope (even the yellow isolation scopes can help some, but they are hard to hear in even with someone with experienced ears) and listen every day, and listen to other people.  Get used to "normal" lung sounds vs wheezing and rales, AND just as important is how he responds to the Ventolin.  Then you'll have a better idea of when to give the drug, and when he's short of breath because his nose is plugged.

Then, if you can, see a naturopath.  The supplements we use are quercetin (it's totally kicked an asthma attack to the curb for my daughter, and without steroids), I rub castor oil on my son's chest before bed, and give him Flax Seed Oil (cold liver oil, and even Omega-3's work too, the good fats help bring down inflammation).  All those things can be bought on this side  of the border if you or anyone is coming this way.  A naturopath might be able to recommend other things, too.

The other thing I wanted to say about a daily inhaled steroid is that it is pretty safe.  The nice thing about inhaled steroids is that they only go where they are needed, very very little goes into the blood system.  My 9 year old was considered disabled until 3 or 4 due to his asthma, and I really worried about the flovent.  There was a study some years ago comparing 3 groups of children:

1) Children who used only Ventolin (we call it albuterol, same stuff)

2) Children who used steroids for a long duration (prednisone/prednisolone) plus Ventolin

3) Children who used Flovent, Ventolin as needed, and occasional bursts of steroids.

The 3rd group had the best growth, missed the fewest days of school.  I don't always agree with these studies, but this one makes sense to me.

So continue to use the Ventolin as needed, maybe pull in additional helps (both western medicine and traditional medicine), and learn to listen to lung sounds (here's a place to get you started http://www.wilkes.med.ucla.edu/lungintro.htm ).  And honestly, if you hear the wheezes both IN and OUT you probably need additional help beyond inhalers and should head to the doctor.  Especially if they don't change much after your typical 2-4 puffs.

Also, some signs of respiratory distress in children, so you can learn to assess where he is at:

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/respire/signs.html

Learning the signs of respiratory distress:

Children who are having a difficult time breathing often show signs that they are not getting enough oxygen, indicating respiratory distress. Below is a list of some of the signs that may indicate that your child is not getting enough oxygen. It is important to learn the signs of respiratory distress to know how to respond appropriately.

• breathing rate
  An increase in the number of breaths per minute may indicate that a person is having trouble breathing or not getting enough oxygen.
   
• color changes
  A bluish color seen around the mouth, on the inside of the lips, or on the fingernails may occur when a person is not getting as much oxygen as needed. The color of the skin may also appear pale or gray.
   
• grunting
  A grunting sound can be heard each time the person exhales. This grunting is the body's way of trying to keep air in the lungs so they will stay open.
   
• nose flaring
  The openings of the nose spreading open while breathing may indicate that a person is having to work harder to breathe.
   
• retractions
  The chest appears to sink in just below the neck and/or under the breastbone with each breath - one way of trying to bring more air into the lungs.
   
• sweating
  There may be increased sweat on the head, but the skin does not feel warm to the touch. More often, the skin may feel cool or clammy. This may happen when the breathing rate is very fast.
   
• wheezing
  A tight, whistling or musical sound heard with each breath may indicate that the air passages may be smaller, making it more difficult to breathe.

The signs of respiratory distress may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

[stik]

Originally Posted by DevaMajka 


So would you use the puffer every 4-6 hours from the start of a cold, or would you wait for a sign of breathing symptoms? Dp is leaning toward using it a few times a day from the first sign of a cold. He may be right. I just have it so ingrained in me to worry about medicine, kwim? I guess I never realized before how freakin' scary it is to have a kid who can't breathe properly.

I would use it from the first sign of a cold.  

[DevaMajka]

So it sounds like the general consensus is to do what the doctors said, and use it from the first sign of a runny nose/cough/cold. Alright- it makes me feel better that I didn't hear conflicting advice from here, kwim?

Originally Posted by stik 

With 2 hospitalizations in a month, I'm surprised that's all your son has been prescribed

I wonder if it's because he responded quite well to it? Or maybe they were hesitant to assume it would happen again?

Originally Posted by coyotemist 

Invest in a cheap stethescope (even the yellow isolation scopes can help some, but they are hard to hear in even with someone with experienced ears) and listen every day, and listen to other people.  Get used to "normal" lung sounds vs wheezing and rales, AND just as important is how he responds to the Ventolin.  Then you'll have a better idea of when to give the drug, and when he's short of breath because his nose is plugged.

Then, if you can, see a naturopath. 

Both really good ideas! I'm going to look into getting a stethoscope. Hopefully they aren't too $$!
I've been thinking about taking him to a naturopath for his eczema and digestion issues, too. So maybe now's the time to do it.

Thanks for the links, too

[stik]

I think every doctor has their own threshold for when to diagnose asthma and prescribe maintenance medication.  The mysteriousness and severity of your ds's breathing issues would be really frightening to me, but maybe your doctors have seen a lot of cases like his that don't recur a third time.  Who prescribed the meds?  Was it his regular doc or the doc on staff at the hospital?  Does he have a regular doc?  I'm wondering if maybe the prescribing physician isn't fully aware of his history. 

I also know that for many docs, the criteria for diagnosing asthma is three incidents, so your doc might just be waiting for incident three before offering preventative medication.  A lot of insurance plans won't cover a nebulizer or prophylaxis without an asthma diagnosis that meets the "three incident" criteria.

[coyotemist]

Our old ped diagnosed asthma based upon a scoring system.  Looking for the link...

http://asthmatracktest.com/

They said that since my little guy wheezed, the wheezing gets better with albuterol, and the rest of us have asthma, he has asthma.  I contend that the 3 times he's wheezed have been after he aspirated, or when he had RSV.  But that's a whole different story..