My 10 year-old son has had two exercise indused asthma attacks
before this year.  He has had three attacks since last summer
that were chronic in nature (not an event, but rather his lungs
developed a wheeze that progressively got worse).  Those three
times his gp prescribed a strong/week-long cycle of prednisone.
Each time this cleared his lungs.

The second event/treatment, last October, left him with a
chronic stomach ache, a known side-effect (we guess the
prednisone did it, they did an upper gi, in December, no ulcer
detected).

"The Complete Book of Children's Allergies, A Guide for Parents",
by B. Robert Feldman, M. D., from Columbia Presbyterian Med
Center, ISBN 0-8129-1211-X, lists the side-effects of extended
steriod use, and my son showed most of them within days, weight
gain (5 lbs, in a week), moon face, headache, insomnia, bad
stomach ache, etc.  The text says that this is not supposed to
happen until after two weeks of use.

So, why does he get these side-effects?  Is the dose to strong?
I assume this will happen again, in the spring, when the plants
are active, he has always had allergies to various pollens,
dust, molds, etc.  Should we avoid prednisone?  If so, when his
lungs are stressed, what do we do?  He already takes the daily
inhaler of cromolyn sodium (Intal) and uses albuterol sulfate
(Ventolin) when he begins wheezing.  He has taken the Intal,
daily for the last year and a half.

I don't want to give him the steriod again.  What are the
alternatives?
======================================================================

: My 10 year-old son has had two exercise indused asthma attacks
: before this year.  He has had three attacks since last summer
: that were chronic in nature (not an event, but rather his lungs
: developed a wheeze that progressively got worse).  Those three
: times his gp prescribed a strong/week-long cycle of prednisone.
: Each time this cleared his lungs.
:
: The second event/treatment, last October, left him with a
: chronic stomach ache, a known side-effect (we guess the
: prednisone did it, they did an upper gi, in December, no ulcer
: detected).
:
: "The Complete Book of Children's Allergies, A Guide for Parents",
: by B. Robert Feldman, M. D., from Columbia Presbyterian Med
: Center, ISBN 0-8129-1211-X, lists the side-effects of extended
: steriod use, and my son showed most of them within days, weight
: gain (5 lbs, in a week), moon face, headache, insomnia, bad
: stomach ache, etc.  The text says that this is not supposed to
: happen until after two weeks of use.
:
: So, why does he get these side-effects?  Is the dose to strong?
: I assume this will happen again, in the spring, when the plants
: are active, he has always had allergies to various pollens,
: dust, molds, etc.  Should we avoid prednisone?  If so, when his
: lungs are stressed, what do we do?  He already takes the daily
: inhaler of cromolyn sodium (Intal) and uses albuterol sulfate
: (Ventolin) when he begins wheezing.  He has taken the Intal,
: daily for the last year and a half.
:
: I don't want to give him the steriod again.  What are the
: alternatives?
: ======================================================================

Some people are much more sensitive to steroid side-effects than others, and your
son may be among these. It's hard to say whether the dose is appropriate without
knowing the dose and how much your son weighs, though.

  There are several other things you should try doing.

1. Continue using the intal regularly.
2. Use the ventolin one-half to one hour BEFORE exercising; many with exercise-induced
asthma can avoid attacks by doing this.
3. Use the ventolin regularly (2 puffs four to six times a day) whenever he seems to
be having an allergy attack or a cold, or is otherwise having trouble, and as needed.
Ventolin has for most people no side effects, even when used daily, and you
can't really overdose on it (if you use it too much, it may make your heart race or
make you jittery, but rarely anything else).
4. If the above still don't help, consider a steroid inhaler (sample brand names
azmacort, beclovent; avoid aerobid - it tastes bad). These are very effective but
have many fewer effects than {*filter*}prednisone because the dose is MUCH smaller.
If his problems are seasonal, he could use a steroid inhaler for just those times of
year, which would minimize side effects as well. One note about steroid inhalers -
brush your teeth or rinse your mouth out after every use, to avoid a yeast infection.
5. An overall point: make sure he's using the inhalers properly. The idea is to
get the medicine into the lungs, not spray the back of the throat. Many patients
put the inhaler in their mouths, spray, and inhale; this wastes most of the medicine.
(I've even seen package inserts that say to do it this way, but they're wrong.)
Hold the inhaler about one inch in front of your wide-open mouth. Breathe out all the
way, then take a deep breath. Fire the inhaler AS YOU ARE BREATHING IN. Hold the
deep breath for a few seconds, then inhale. repeat once.

Good luck,

Brandon Brylawski, MD

IMHO, good inhaler "technique" is too difficult for most kids to master,
especially if they don't take the stuff regularly, regularly, regularly.  But
now that doesn't matter.  You can get one of those AeroChamber-things to put
between the inhaler & the kid's mouth.   This works real well, but costs about
$30 (I think).  The other thing that works (& is free):  If you've ever had a
prescription for Azmacort, it comes with its own aerochamber-like device.  When
the inhaler is empty, discard the cannister, but keep the inhalation-device.
Ventolin refills fit into it real well, & your kid can get all the med without
having to learn fussy inhaler "technique".

------------------------

Philosophy Department;Wesleyan University;USA

My 8yo son got asthma as a complication of an upper respiratory virus he had
a few months ago.  The dr prescribed Ventodisk inhaler, which dispenses
in powder form.  The inhalation of the medication is "breath-powered", and
this is supposed to be easier for kids because they don't have to coordinate
the breathing and spraying.  But I understand that the drawback is that it is
a less efficient delivery method, so aerosol inhalers are preferred if they
can be properly used.
--
Seanna Watson   Bell-Northern Research,

Opinions, what opinions?  Oh *these* opinions. | It's hard to seize the
No, they're not BNR's, they're mine.           | day when you must first
I knew I'd left them somewhere.                | grapple with the morning.

:
: > 5. An overall point: make sure he's using the inhalers properly. The idea is to
: > get the medicine into the lungs, not spray the back of the throat. Many patients
: > put the inhaler in their mouths, spray, and inhale; this wastes most of the medicine.
: > (I've even seen package inserts that say to do it this way, but they're wrong.)
: > Hold the inhaler about one inch in front of your wide-open mouth. Breathe out all the
: > way, then take a deep breath. Fire the inhaler AS YOU ARE BREATHING IN. Hold the
: > deep breath for a few seconds, then inhale. repeat once.
:
: IMHO, good inhaler "technique" is too difficult for most kids to master,
: especially if they don't take the stuff regularly, regularly, regularly.  But
: now that doesn't matter.  You can get one of those AeroChamber-things to put
: between the inhaler & the kid's mouth.   This works real well, but costs about
: $30 (I think).  The other thing that works (& is free):  If you've ever had a
: prescription for Azmacort, it comes with its own aerochamber-like device.  When
: the inhaler is empty, discard the cannister, but keep the inhalation-device.
: Ventolin refills fit into it real well, & your kid can get all the med without
: having to learn fussy inhaler "technique".

An excellent point. If your child can't get the hang of using an inhaler properly
(and many {*filter*}s can't either), get ont of the above devices, often referred to as
a "spacer" . This is a collapsible cylinder that attaches at one end to the
inhaler. You put the other end in your mouth,fire the inhaler, and take an immediate
deep breath. A perfectly good method of administering the drug; the only disadvantage
is that you have to carry the spacer around sometimes.

Brandon Brylawski

inhaler properly> (and many {*filter*}s can't either), get ont of the
above devices, often referred to as  a "spacer" . This is a collapsible
cylinder that attaches at one end to the
and take an immediate deep breath. A perfectly good method of administering
the drug; the only disadvantage

Or teach the child (or {*filter*}) to make a "spacer" out of the appropriate
number of knuckles of the other hand. (i.e., cup the fingers around
the end of the inhaler to form a partial tube).

I'm jumping in here, so forgive me if I missed an important prior
message.  My six-year-old uses an InspirEase "spacer" with his various
inhalers. With a little practice, he's gotten quite good at it. He has
also used my AeroChamber, but the Inspirease gives better feedback to
the child, since some kids don't know an inhalation from an
exhalation.  The best form of administration, especially during a
respiratory illness is the motorized nebulizer, which delivers the
medication over a longer period of time and with added moisture, which
seems to help.

--
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Mark Feblowitz,   GTE Laboratories Inc., 40 Sylvan Rd.  Waltham, MA 02254