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Asthma

Viral Induced Asthma

12/28/2006

Question:

I`ve read that Rynatan should not be given to children under 12 but it has been prescribed for my 4 year old daughter. while prone to various allergy symptoms since I adopted her at 13 months, allergy tests have never come back positive. On Jan. 2, 2006 she began having breathing problems after exposure to strep - tested positive 3 times since & once prior. 6 months of issues culmunated in having tonsils & adenoids removed july 5. (very noisy breathing, some apnea) 1 month symptom free was followed by about a month of hives coming and going. Another 6-8 weeks symptom free and she started with a dry cough that increased in frequency and was followed by a nasal drip that became a flood before phenclortanpedi brought it under control. But the cough did not get under control so back to the doctor, who prescribed bringing back xopenex via the nebulizer (but saying she doesn`t have asthma). I since learned from the sitter she was exposed to bronchitis in nursery school. Researching to try to get all the meds and uses straight, I`m not liking what I read about either med and wondering whether singulair and zyrtec (previously prescribed for the hives) would be better and less risky. The poor thing is back to not getting enough sleep and I heard her snoring a couple of times again for the first time in months.

A friend who heard the symptoms the 1st time around said her son had same years ago and after a year of no progress was ultimately diagnosed with viral induced asthma. The name sounds right on, but everything i`ve read about it connects it to the common cold, which doesn`t seem to fit.

Maggie`s other allergy like symptoms, not occuring at same time, have included excema, a tendency to regurgitate or even vomit her food if she takes too much in a mouthful (more frequent at 18 months but has happened on occasion in last year). she does also complain of itchiness on occasion recently.

I also use a house humidifier and a room humidifier and keep the heat at 68.

would it be appropriate to go back to the ENT at this point?

Pulmonologist wanted to do a sleep study back when, but based on niece`s experience i couldn`t see putting her through it if the tonsils/adenoids were coming out anyway.

Allergist said he was satisfied with the results of the prior testing and saw nothing further to test.

THANK YOU!!!

Answer:

Your daughter's history certainly sounds complicated, and I don't think it will be possible to sort it out in this message, but I will offer some thoughts. I gather the worries have revolved around symptoms which include runny nose, cough, and at times "breathing problems" with some night time snoring thrown in as well. She has also had problems with eczema, hives, and spitting up. She's probably had some plain old common respiratory viruses, as well, contributing to her troubles. So far, she's been evaluated for allergies, and tried on a variety of antihistamines or meds with antihistamines in them (including Zyrtec and rynatan. . . zyrtec is a new agent, rynatan has been around a long time - before companies were required to do studies in children, so was never officially "approved" in under 12, although has been used in that age group.) She's been prescribed some medications that are typically used for asthma, although that diagnosis has not been made "official" at this point. Removal of her tonsils and adenoids helped temporarily. So far, you've seen a variety of doctors for her, including her primary care doctor, and an ENT, allergy, and pulmonary specialist. Sounds like you've been getting different advice from different doctors - who are each trying to solve her problems via different approaches. This is adding to the confusion. I would recommend, first, that you sort out which of your daughter's health problems are worrying you the most, then approach your primary care doctor with a plan to enlist his/her help along with perhaps one other doctor/specialist. Since the allergist and ENT doctors have come close to doing the most they can do, the pulmonologist might be a good pick - but your primary care doctor may have some thoughts on this as well. Make sure that your PCP and specialist are aware of all the medicines you are giving your daughter, so you don't "double dose" them. Chronic coughing, in particular, has a number of possible causes even in otherwise healthy children, including asthma, post-nasal drip due to allergies or chronic sinus infections, and gastroesophageal reflux. Snoring at this age can be a sign of actual trouble getting air at night - or simply a child who is "noisy", but is breathing fine. The nasal drainage may reflect bad luck (one cold virus after another), a chronic sinus infection, allergies, or "non-allergic rhinitis" - a runny nose with no specific cause, but still some treatment options. Unfortunately, sorting all this out may take some further tests, and some further trials of medicine. A well thought out, and step by step, approach is going to take time - but may be the best way to get things turned around. When you are giving medication on a trial basis, have patience (many take a couple weeks to really start working) and notify your doctor if something you've read, or some suspected side effect, makes you want to stop. Keep in mind that all medicines have potential side effects - many people never experience them, and sometimes the risk is "worth it" depending upon how bad the symptoms are you're trying to treat. So - regroup with your doctor(s), try to follow one plan at a time, and if you're confused about the medications - ask questions.

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Response by:

Elizabeth D Allen, MD Elizabeth D Allen, MD
Clinical Associate Professor of Pediatrics
College of Medicine
The Ohio State University