Asthma diagnosis for 2 year old

[Anonymous]

Hello everyone,

I am not sure what to think - my 2 year old was diagnosed with asthma by our ped today. We were at the ER this weekend and the diagnosis was Reactive Airway disease. But this was the third time we ended up in the ER in the last 18 months or so. Not each time, but like every second or third time, when my son has a cold, he starts wheezing very heavily and has a shortness of breath, so we have to use the nebulizer and the ER prescribes steroids.

I was jut looking for feedback from other moms whose child is or was in the same situation. I read that about 2/3 of children outgrow this by age 5; but I really don't know what to expect. Our ped went over a suggested treatment plan for potential future episodes, to prevent the need to go to the ER.

Thanks!

[Anonymous]

Hi OP-
Similar "diagnosis" here when my son was 18 months and at 7 he no longer wheezes. Your son has reactive airways which is not uncommon at his age. If he doesn't grow out if it, the diagnosis will officially be asthma (i believe that they look for kids to outgrow it @ 5).

My advice:
1. See a pediatric pulmonologist. Once the pedi started talking about daily inhaled steroids, I wanted a specialist
2. Get the attacks under control. With your action plan, your son will be less prone to attacks that end up in the er.
3. Figure out if there is an allergy component. Is it just colds that makes him react? For my son, it was only colds occurring during the spring allergy season. With allergy meds it kept him from having an asthmatic reaction once a cold started
4. As he gets older, fewer colds will mean fewer reactions, even if he is a full blown asthmatic
5. Don't be afraid to use the nebulizer early and often.

[Anonymous]

Pp here. They will put your son on a daily steroid like pulmicort or Flovent. These are much healthier than 1 dose of oral steroids so don't be afraid to use them. Some kids have bad reactions to them but we never had an issue.

[Anonymous]

this is OP -thanks for your comments. Actually, the ped came up with suggestions and a treatment plan, so we do not have to use the steroids in the future. I will look into a good pediatric pulmonologist - any recommendations? For it seems, that it is only the cold / virus that triggers the wheezing episodes, at least that is what I am thinking.

[Anonymous]

My son had the same diagnosis at that age. He's 8 now and still needs his inhaler when he gets a bad cold. Regular runny nose type virus doesn't get him wheezing, just the serious congestion type illnesses, which seem to come 3-4 times a year mostly in the winter. The rest of the year he is a super active athletic boy.

[Anonymous]

My 7 year old son has asthma. Same presentation as yours. Totally fine most of the time but an upper respiratory infection often made him wheeze. One winter was bad enough the pedi had him do daily neb treatment with pulmicort as a preventive for about a month. But for years it was only treat when sick.

Fast forward to last winter and it seemed to change. He had fewer episodes while sick with a cold but seemed triggered by exercise in gym class. So he changed up to a daily inhaler of albuterol on PE days at school. So while the asthma on the upper respiratory side seemed to get better, the exercise induced asthma was a new thing. But I thought it was under control.

He got very bad very fast at school one day last spring, though, and they had to call 911. He was in the hospital 3 days and was so bad they used magnesium and almost had to transfer him to Children's. But he pulled through. They gave me a little plastic breathing tester (can't remember the name) where he blows as hard as possible and I can measure output on a graph. So his personal best is 250. When it starts falling I know to be on alert. And I got an asthma action plan on how to treat different symptoms. He was also put on 2 preventive drugs, Flovent and Singulair. I hate daily drugs but I hate my kid not breathing worse than that. He wS able to wean down to just Singulair. I am keeping an eye on him this fall for colds, etc. But fingers crossed this treatment plan will continue to work. He spent all summer at sports camps and never had an issue. He hasn't yet had a cold so I don't know how that will work.

Besides seeing a pulmonologist, which is a good idea, three more things: 1) get a flu shot (for him, family) if you don't already do that. If your child is susceptible to breathing problems causing asthma, it's best to prevent and minimize.
2) ask about a treatment plan if he's in day care or going off to preschool next year.
3) watch out for this enterovirus making its way here from the Midwest. It has a high hospitalization rate from wheezing.

Good luck.

[Anonymous]

I would see a pediatric allergist and talk over your sons history with him or her. Our Son started having breathing issues at 6 months old. By 9 months it was clear it was a problem and first was diagnosed as RAD. He went on daily Pulmicort via nebulizer. At 18 months he received a diagnosis of asthma. It was based on history, incidents and response to medication. At nearly 3 he takes Pulmicort once a day via nebulizer and we up it to twice a day at the first sign of a cough or runny nose. He has been in the hospital once this year. The maintenance meds have cut down his need for oral steroids like prednisone which are much more highly concentrated. He has the standard albuterol for emergencies.

You sound skeptical and while that is ok it should not be at the expense of your kid's health. Find another doctor and get a second opinion. And if the diagnosis is RAD or asthma and your doctor feels a daily maintenance med is required make sure you find a doctor who will experiment to get your kid on the lowest dose possible. It took us about 4 months to find the right medicine and dose but once we did it was a huge difference.

DC us totally fine 95 percent of the time while on the Pulmicort. The other 5 percent is just scary. Good luck with all this. It can be overwhelming.

[Anonymous]

At 2, my son had the same progression -- RAD to asthma. The doctor we saw -- Dr. Scarupa at Allergy and Asthma Institute said there was no correlation between having asthma at 2 and having it at 5. And, indeed, at 4, my son needs his inhaler far less and can handle colds much better.

Also, talk to your doctor about getting an inhaler with spacer and mask instead of a nebulizer. It doesn't work if your child is actively fighting it, but otherwise it's so much easier.

[Anonymous]

Same here. Our ped gave me a list of possible triggers and I eliminated all the ones we could in our house and the RAD went away. For use, it is scented laundry detergents, dryer sheets, air fresheners, scented shampoos and lotions, etc. For me it was totally worth it to live scent-free. We never use the inhaler or nebulizer anymore. I get from reading DCUM that a lot of people don't believe you can get rid of asthma but we did it. There was an interesting call-in show on WAMU a few months ago about this and the experts on the show agreed there is an environmental component. Good luck OP.

[Anonymous]

We used to regularly use our nebulizer during colds. As my DD got older, we needed it less (and they get sick less often). When she was 6 she got pneumonia but an early doctor's visit and shot of antibiotics kept it from getting too serious. We take her colds pretty seriously, and we've never ended up in the ER. However, she still has an asthma diagnosis and takes a combination inhaler 2x a day because she was using the ProAir too often, mostly after exercising which developed around age 7. It seems well managed, and she is an active sporty girl now at age 10.

[Anonymous]

I agree with a lot of what has been said. I have two kids with asthma- a 4 year old and a 2 year old. Initially my 4 year old's asthma was called RAD.
Here are my suggestions- in no particular order;
1. inhaled steriods (pulmicort/ qvar) are much better than having to do prednisone- use them.
2. Asthma is an individual disease, you need a doctor that looks at your kids asthma as an individual and figures out the right treatment plan for him-- I have a fantastic pediatrician who is great at treating asthma, but many people go to a ped pulmonologist for this.
3. It often helps to take notes on what was going on when he started wheezing. Keep on asthma journal. You may be surprised at what you find. Write down every cough/wheeze. This was instrumental for us in determining triggers. Ex- we know give a puff of albuterol before he goes outside to play when it is cold, it keeps asthma attacks at bay.
4. Your pediatrician should have had you do the inhalor in front of her-- if you have not done this take it with you so you can make sure you are administering it correctly. There is now a clinic at Children's devoted to teaching people how to administer asthma mediciations correctly since so many people don't.

[Anonymous]

My son was diagnosed with asthma around the same age - 18 months. Basically, a cold could progress to pneumonia quickly. Another unfortunate circumstance; asthma and allergies go hand in hand. He has year round allergies and carries an epi for allergies to certain trees and bees. The upside? He's 7 and has given himself the injections Another upside; it could be worse.

He now does weekly allergy shots and takes it like a champ. He also graduated from the nebulizer to an inhaler recently as well. He carries his epi everywhere and understands why he needs it.

[Anonymous]

OP you need to take your child to a pediatric ashtma specilist. My 20 month old ws diagnosed by Athena Economides (recommended on this board). They did lots of allergy testing as well. My DD would start with a cold that would devolve inito weeks of wheezing, shortness of breath and one trip to ER. Dr economidies believes my DD will actually outgrow we minimize future asthma attacks so that her airways will continue to develop normally. We are doing a daily 6 month dose of singulair (although it has a new brandname), a daily probiotic recommended from Prediatriction, and have a nebulizer for emergencies. So far things have been hugely improved. We haven't had to use the nebulizer in three months, no asthma attacks at all. I think the probiotic is actually quite helpful. SIngulair is NOT a steroid and thats good. You def need another opinion before you start your kid on too many sterfoids if there are other options.

[Anonymous]

Anonymous wrote:Same here. Our ped gave me a list of possible triggers and I eliminated all the ones we could in our house and the RAD went away. For use, it is scented laundry detergents, dryer sheets, air fresheners, scented shampoos and lotions, etc. For me it was totally worth it to live scent-free. We never use the inhaler or nebulizer anymore. I get from reading DCUM that a lot of people don't believe you can get rid of asthma but we did it. There was an interesting call-in show on WAMU a few months ago about this and the experts on the show agreed there is an environmental component. Good luck OP.

you are misunderstanding the posts. if you have a trigger or an easily identified set of triggers and you can eliminate them from your life, then yes, you can likely eliminate the asthma. But not everyone has a simple case and often the triggers can't be eliminated.

[Anonymous]

OP here - thank you all for the feedback and the recommendation to Dr. Athena Economides. I just made an appt with her for my son. Appreciate it.