Non-steroid alternative for toddler asthma?

October 3, 2009 2:52 PM

allergist wants to put our two-year daughter old on FLOVENT -- wife and I would prefer to avoid giving her steroids - is CROMOLYN as effective for cold virus-induced asthma in a toddler?
posted by LittlePumpkin to health & fitness (24 comments total)

It is worth nothing that inhaled steroids do not have the same systemic effects as oral steroids, so you might not have anything to worry about. (Also, corticosteroids != anabolic steroids, in case you had that association in your mind.)
posted by jrockway at 3:10 PM on October 3

This is really something that you should speak to your allergist about. If you don't want to make another appointment, call her office and ask to speak to her about it. If your daughter's asthma is bad enough for her to be seeing an allergist, you need to be careful about what you use for her.

And yes, the steroids are not systematic like, say, prednisone, if that's what you're worried about. My ENT doctor specifically talked to me about that last week, because I had similar concerns about Nasonex.
posted by kathrineg at 3:36 PM on October 3

Cromolyn looks like it is a nasal spray which is very different from a puffer like flovent (and is a different drug - mast cell stabilizer vs inhaled steroid). Asthma (or bronchiolitis as is likely the holding diagnosis given the age of the child) is a problem with the lungs where the airways (bronchioles/bronchi) get tight stopping air from getting out and producing the characteristic wheezing. Nasal sprays just get medicine to the mucosal layers of the nose not into the lungs.

Don't worry too much about flovent being systemically absorbed. As kathrineg and jrockway have already mentioned, this is not the same as taking oral steroids.

Your daughter should be using an aerochamber with her puffer. This allows for better medicine delivery to the lungs which also means that less sits in her mouth for her to swallow.

Also, remember that flovent is not going to make her feel better right away - only atrovent/ventolin does that. The flovent is a longer term medication that she will need to take for a couple of weeks when she gets wheezy (if she just gets sick when she has a viral infection).
posted by madokachan at 3:48 PM on October 3 [1 favorite]

Short answer: No.
Longer answer: No. Speak with your allergist for more information.
Longest answer: Your question is predicated on a number of conditions, making it difficult to answer.

Your allergist is likely to be more qualified than most of the people here. Additionally, your allergist is likely well aware of various asthma guidelines, studies and pathways which would have informed his decision to put your daughter on Flovent.

For example, the latest asthma guidelines offer pathways on the diagnosis and management of asthma based on symptoms. It also very clearly states that inhaled corticosteroids, such as Flovent, are the preferred drug of choice in the management of persistent asthma. It addresses the concerns of growth rates in children vis-a-vis the use of corticosteroids.

There are a number of studies addressing the suppression of growth in children when they're using inhaled corticosteroids. And while short-term growth may be affected, final height and development is not.

Want to read more? Google up "EPR-3" for the latest and greatest recommendations on the diagnosis and treatment of asthma. I'm a physician, and I've read this and other studies. Were I to have a child with asthma, I'd take the recommendations of an allergist or pediatrician over my own judgement, and certainly over the suggestions of any MeFite. For I would heed the advice of a doctor, who would shoulder the responsibility of my kid's health and well-being, over anyone whose burden and risk is limited to being de-Favorited.

ASTHMA: IT KILLS! DON'T FUCK AROUND.
posted by herrdoktor at 3:49 PM on October 3 [20 favorites]

I don't think you're going to do better than herrdoktor's advice.

But madokachan's statement that "Cromolyn looks like it is a nasal spray," is not necessarily correct. Cromolyn sodium comes in other forms, at least one of which is for use in a nebulizer for inhalation to help treat asthma and I think there are other delivery systems (standard inhaler etc.) as well.
posted by Quinbus Flestrin at 4:22 PM on October 3

Mother of a severe asthmatic chiming in. The newer preventative inhalers are a godsend. Prior to them becoming available my daughter ended up in hospital pretty much every time she contracted an URTI - sometimes only hours after having seen the doctor. She spent a huge amount of time on a nebuliser, often having Atrovent and Ventolin hourly in addition to Becotide and something else I've now forgotten - not much fun for a toddler.

The minute the the combined long acting bronchodilator/steroid inhalers became available her asthma improved. She's had one attack in over 12 years now and that was in the middle of Sydney being deluged in smoke from bushfires.

We haven't become complacent - a friend's adult child died a couple of years ago from their first asthma attack in over a decade - but the newer preventatives have changed the lives of many asthmatics, including my daughter. Just remember that even if your daughter's asthma becomes stable, you still need to maintain a current asthma plan and keep emergency medications on hand.

FWIW, it's possible that your daughter may still be treated with prednisone if she has an respiratory tract infection - don't confuse the two types of steroids, they're used for different things and not interchangeable (I recall that prednisone could only be given to my daughter in hospital until she was about three or four, but prescribing restrictions vary greatly from one place to another).
posted by Lolie at 7:27 PM on October 3

Speaking as someone who has asthma, and has tried several different methods of control/prevention - please do whatever WORKS. I'm 26 now, have had asthma since I was a young child. Nothing has worked better than the steroid (as others have said, its not what you might think) inhalers.

When I get an attack and do not have an inhaler nearby, it is the worst feeling - because there is absolutely nothing I can do, short of sitting and breathing slowly and calmly - and this doesn't make it go away/get better, it just keeps me alive until I can get an inhaler/something else.

So yes, please follow the allergist's advice, or at least speak to them about your concerns so that they (not mefi) can address them intelligently - but whatever you do, please make sure your daughter is comfortable: asthma attacks are a horrible feeling, both physically and mentally, and no child should have to suffer through them.
posted by ish__ at 7:55 PM on October 3

Quinbus - Thanks for the correction. I'm not familiar with cromolyn (as I don't think we have that particular drug in Canada but I may be wrong on that too). I googled it quickly and got just the nasal spray. I see now that it is dosed in inhaler form as well and is a leukotriene receptor antagonist. Here, we sometimes use a similar drug called montelukast (Singulair).

As has been mentioned mutiple times the beta agonists (bronchodilators), inhaled corticosteroids and oral steroids for exacerbations are the backbone of asthma management. Leukotriene antagonists are generally used as adjuncts if at all.

I can't stress the aerochamber/spacer use enough. I see so many people who use their inhalers improperly and kids really can't coordinate the whole exhale-press-inhale-hold routine.
posted by madokachan at 8:51 PM on October 3

What does your second doctor with the second opinion think?
posted by rokusan at 9:29 PM on October 3 [1 favorite]

I had asthma since I was 3. I was on all varieties of drugs, preventative, acute response, etc. 10 years ago I took a course in the Buteyko method. I practiced the breathing techniques for 5-6 months and my asthma symptoms were completely eliminated (and more) permanently. It convinced me that the western approach to asthma was completely symptom treating, inherently wrong and the medications only act to exacerbate the symptoms in the long term.
posted by blueyellow at 10:07 PM on October 3 [1 favorite]

I had asthma since I was 3. I was on all varieties of drugs, preventative, acute response, etc. 10 years ago I took a course in the Buteyko method. I practiced the breathing techniques for 5-6 months and my asthma symptoms were completely eliminated (and more) permanently. It convinced me that the western approach to asthma was completely symptom treating, inherently wrong and the medications only act to exacerbate the symptoms in the long term.
I would feel much more comfortable taking the recommendations of a panel of experts, who've extensive experience and medical backgrounds and have based their decisions on numerous studies with many thousands of patients, over multiple, conflicting, and small studies of the Buteyko method or the medical advice of anyone whose suggestions are based on trials where n=1.

Especially when it comes to two-year-olds.
posted by herrdoktor at 10:59 PM on October 3 [4 favorites]

I'm not familiar with cromolyn (as I don't think we have that particular drug in Canada but I may be wrong on that too).

Yep, wrong on both counts. Cromoglicate is a mast cell stabilizer available in Canada over-the-counter as nasal spray, inhaled aerosol or eye drop. I'm in Vancouver, I use it and I find it's very effective.
posted by randomstriker at 12:07 AM on October 4

If the asthma is really "cold virus induced," that means it isn't chronic, right?

A brief course of inhaled corticosteroids poses almost zero risk of any significant complications, and is the frontline treatment of choice.

AskMe is not a doctor. Listen to the one obvious physician in this thread.
posted by fourcheesemac at 5:52 AM on October 4

It convinced me that the western approach to asthma was completely symptom treating, inherently wrong and the medications only act to exacerbate the symptoms in the long term

This, of course, is utter nonsense.
posted by fourcheesemac at 5:53 AM on October 4 [1 favorite]

Other option: give your child hookworm.
posted by Hildegarde at 6:49 AM on October 4

My apologies again, randomstriker. An explanation (but not excuse) for my ignorance is the fact that I never prescribe mast cell stabilizers from the emergency department for acute asthma exacerbations.

LittlePumpkin, if you would like to see some of the evidence, here is the latest Cochrane Review on the topic: Inhaled sodium cromoglycate for asthma in children. And this one comparing comoglycate to inhaled corticosteroids.
posted by madokachan at 7:02 AM on October 4

The nonsense is believing that you need to be hostage to medications for the rest of your life because that's what you are told.

About the panel of experts, if they all have the same inherent bias, ie they all basically studied the same exact western medicine then it is tantamount to consulting with only one perspective with some variance in the response. Also, about the independent studies, if they are sanctioned by drug companies then they also have a very strong bias, the presupposition that asthma should be cured by administering drugs.

Personally I would be much more impressed with scientists than doctors. Doctors are more like mechanics than car designers. Their opinions aren't the product of study and analysis, rather the regurgitation of what they read or heard integrated with some first hand knowledge of what treatments they prescribed worked.

About my statement:
It convinced me that the western approach to asthma was completely symptom treating, inherently wrong and the medications only act to exacerbate the symptoms in the long term

This is actually very important to consider. The Buteyko method holds the premise that asthma (like some other types of chronic symptoms) is a symptom of an underlying disorder, chronic hyperventilation. The idea being that people that chronically breath too much, i.e. breath too deeply constantly are throwing their physiology out of alignment. Specifically they are distorting the balance of oxygen and CO2 in their bodies. If you think about the symptom your body generates for this condition, constricting your airflow, is very apropos for the condition of chronic hyperventilation.

Now consider the medications given for asthma. They are basically of two varieties bronchodilators and steroids. What do the bronchodilators do? They literally open up your lungs. In the short term you feel some relief as the lungs which were previously constricted are now open (in the short and long term). But the effect of this is to ultimately cause you to breath more, to hyperventilate more. For one, this actually will increase the frequency of your symptoms as you're more constantly CO2 deprived, and second, it might increase the chance of higher severity as your body's response was stopped and it might respond more strongly the next time. In contrast the steroids are inherently anti inflamatories mitigating the bodies response. So they are actually not as destructive and given the option I would much rather take them or prescribe them to a 2 year old (Flovent). At least until she was old enough to learn the breathing exercises that train you to not hyperventilate.
posted by blueyellow at 7:48 AM on October 4 [1 favorite]

Blueyellow, your comments and position regarding the treatment of asthma are examples of the reasons why I tend to avoid medical questions here. I consider myself to be open to "complimentary" alternative medicine, and do indeed believe that medicine is always evolving.

However, western medicine does the best it can, with evidence based medicine.

I've never flagged a post here, and have always hestitated getting myself involved in such action, but I will flag your post for being as stupid, short-sighted and dangerous.

Anyone else following this: please strongly consider the risks versus the benefits of following the advice of anyone on the internet. I hope the layperson would understand that he or she should avoid any course of action where the risk includes death or dying.
posted by herrdoktor at 9:46 AM on October 4

The idea being that people that chronically breath too much, i.e. breath too deeply constantly are throwing their physiology out of alignment.

Diagnosed as asthmatic 37 years ago at age 8. Have been on a combo of streroids+bronchodilator for 20 years now, currently pulmicort+serevent. Almost never--maybe 5 times a year--have to use my rescue inhaler.

This is the thing: My asthma was always worse in early summer, consistent with a (later confirmed) allergy to grass and some tree pollens; despite my asthma's seasonality my docs and I have determined that, as with all asthmatics, year-round preventative treatment would help me more, and it has.

My question for you: Why did I only hyperventilate during grass pollen season?

And for OP: There is nothing whatsoever to fear from inhaled steroids.
posted by ethnomethodologist at 9:52 AM on October 4

Suggest you read up on butekyo method. Blueyellow is correct - it does treat the underlying cause of asthma. And it has been proven in clinical trials, but not in the US.
posted by zia at 10:15 AM on October 4

Thanks everyone for your input -- of course I'm not casting about on MeFi for a definitive answer for what to do -- i'm in close contact with my allergist, and with others for 2nd/3rd opinions - but i'm also gathering info about the debate over steroids vs. other to treat asthma, hence this post.

again, thanks.
posted by LittlePumpkin at 10:17 AM on October 4

[comment removed - thread is not for hobbyhorsing your own ideas, it's for answering the OPs question. Once you've stopped doing that you should probably email folks, thanks.]
posted by jessamyn at 11:31 AM on October 4

This is a wild card but if you find that your daughter does not respond to either type of inhaler, please look into food allergies. I followed my GP and allergist's advice for 2 years put up with regualar inhalers and awfully expensive steroid inhalers that didn't change a thing.

Finally, I went on a gluten-free diet (although my Top Doc allergist told it was pointless. Never mind that he did not test me for food allergies) and my symptoms began to ease and went away after 6 weeks. 8 months later, I'm doing great and don't take a single med.
posted by i_love_squirrels at 10:11 PM on October 4

Just another data point: I have had asthma since I was tiny and have lived through the various improvements in preventive medicine, starting with theophylline (talk about side effects!), cromolyn sodium (Intal - back when you had to insert a little capsule into the "spinhaler," puncture the capsule and inhale the powder) and Flovent starting when it was introduced. It is by far the best I've ever used to control my asthma, never need a rescue inhaler, and (inadvisedly) used it without a spacer with no mouth effects. Good luck!
posted by Pax at 7:05 AM on October 5