Mild reactive airways disease in a five year old

December 1, 2023 3:35 AM

YANMD, but what was your experience with a child diagnosed with mild reactive airways disease? What was your child's treatment plan? Is it normal for a pediatric pulmonogist to do video appointments only (not check the child in person?) When I looked up Alvesco, it says not to be used for under 12 years old. Is there a different one that is OK for a child under 12?

My kid landed in the hospital with pneumonia last spring with a week-long stay. Since then, when my kid got sick again, and I worried about pneumonia, we couldn't get in to see their regular pediatrician because he was out on vacation and family emergencies. So a different pediatrician prescribed abuterol and alvesco with a treatment plan and follow up with a pediatric pulmonologist.
The pediatric pulomonologist appointment was by video only. I asked for in person and they said the doctor does video only for this visit.

She gave us a treatment plan which including the same medications.

My kid has had coughs here and there but nothing serious. We had a standing appointment scheduled yesterday for a follow up during the fall cold and flu season.

He seemed fine yesterday (but had a mild cough for about a week) but starting yesterday afternoon, I gave him the abuterol inhaler. Now it feels like he needs the alvesco because it sounds like lower airways (coughing in the middle of the night) this is danger territory.

Now I feel so stupid for forgetting to ask the doctor about alvesco and why it's being prescribed when it clearly says not for under 12. And if there is an alternative. I haven't been given an explanation from the doctors about this at all.

The appointment yesterday was also a video appointment. I really don't know how she can do anything without listening to my kid's lungs? Or any tests!

I've been so frustrated this past season with my health plan; we're in the U.S.(Kaiser) that I switched and will have a different plan starting in January where I'm hoping to get a second opinion.

Until then, any insight from others would help me. I'm really nervous and feel like a fish out of water here.

posted by AnyUsernameWillDo to Health & Fitness (8 answers total)

Response by poster: He has been coughing and woke up and I just gave him abuterol and for the first time since it was first prescribed, the alvesco. I don't want him to develop pneumonia again so I'm just giving what they prescribed but still wondering why it's not good for under 12! The cognitive dissonance was defeated in this instance.
posted by AnyUsernameWillDo at 4:10 AM on December 1, 2023

So my wife, I, and our kid have asthma (and a pharmacist in the family) and so I am a bit confused as to how you're treating this - alvesco is not a thing you take just when you're sick. It's a maintenance medication and typically takes a couple of weeks for your body to get a real benefit from it. It's about giving your lungs a general boost so they don't get so reactive. It's also safe and prescribed all the time for kids under 12, my 5 year old has been on a lower dose since she was 2.

Are you sure your kid wasn't prescribed to take alvesco every day? That is typically how it works. The albuterol is what you use when they get sick or are experiencing some difficulty breathing - it's the rescue medication.
posted by openhearted at 4:23 AM on December 1, 2023 [7 favorites]

I think Alvesco (or another corticosteroid) is a pretty typical approach with a rescue med like Albuterol. It’s listed on the Mayo Clinic treatment overview for 5-11 year olds.

I’d definitely ask for an in-person follow up visit so that the doctor can listen to your kid’s lungs and possibly order pulmonary function tests.
posted by JuliaKM at 5:17 AM on December 1, 2023 [1 favorite]

Not a doctor, just a mom with a 5 year old who has this.

Call the pediatrician or pulmonologist back and ask about Flovent instead of Alvesco, and ask why Alvesco was prescribed if the package insert says 12+, and double check the instructions for taking Alvesco. Maybe they have an explanation. My 5 yo is on Flovent as a maintenance medicine and it's helping a lot. I'm in the US though, so not sure about availability and insurance coverage in the UK.

As others said, albuterol is the medication you need to help soothe the cough and help him breathe immediately. My son also starts budesonide for 2 weeks as soon as he gets a cough. 4 separate pediatricians from different offices recommended that. But that's not a long term maintenance steroid, just for 2 weeks after he gets sick.

Also, coughing is ok. We do give albuterol at night if the cough is preventing my son from sleeping. But aside from that, we check his respiratory rate, check for retractions while he is breathing and check his oxygen level using a pulse oximeter. If all that is good, we elevate his pillow and try to let him sleep. We check all those things every couple of hours.

When my son saw a pediatric pulmonologist, it was in person. She listened to his lungs but he was 100% healthy when we got the appointment so there was nothing for her to really hear (I knew he didn't have asthma or wheezing on healthy days). She said they don't do any breathing tests until the kid is a little older and is able to follow instructions. So in our case, it might as well have been a virtual visit. However, if you have some time, find someone who does do in person visits, or ask what kinds of visits they do in person so you know if/when you'd get to see the pulmonologist.
posted by dabadoo at 5:55 AM on December 1, 2023 [2 favorites]

I have reactive airway disease/ cold-induced asthma. I had a cold 6 weeks ago and my lungs got irritated/ inflamed, and now I'm coughing. I don't use the steroid all the time, just when I have a flare-up, when I use it 2x/day for as long as I have any coughing or wheezing. The steroid inhaler reduces the inflammation over time.

Cold really aggravates it, so I dress warmly, keep the house a bit warmer. I do use the albuterol inhaler, but prefer to use menthol to open my airways. It's fast and has no side effects. Fishermen's Friend sugarfree cough drops have a lot of menthol. It's 50F, warm for Maine in winter, and I went outside with no problems just now. There are recommendations for anti-inflammation diets, can't hurt.
posted by theora55 at 7:23 AM on December 1, 2023 [2 favorites]

I'm an adult who developed reactive airways in the last decade or so. My experience is that something like Alvesco will just take a week or two to really work. It'll seem like nothing is improving, and then one day the cough will be gone. The Albuterol is more of an immediate open-the-airways-now med; the Alvesco will slowly reduce the inflammation that's triggering the cough.
posted by Blue Jello Elf at 8:39 AM on December 1, 2023 [4 favorites]

Response by poster: I called the doctor and talked to the nurse. Alvesco is inhaled directly into the lungs so it's safer than an oral liquid or tablet steroid.

They don't do spirometry til kids are 7. When I asked why the doctor didn't see my kid in person!

I feel like they are cutting corners. My kid hasn't had his lungs checked since April. But for the time being I'll do this treatment plan and look for new doctors to line up in January.

Thanks everyone. Still welcome to other input just wanted to update
posted by AnyUsernameWillDo at 2:26 PM on December 1, 2023

I can understand your hesitancy but it’s a pretty standard care plan for a kid (minus the suggestion to start on Flovent first, which we did too, but different prescribers have different approaches at this age.) Two prescribers seem to have indicated similar meds which is comforting.

My kid has pretty severe asthma and most of our conversations with our care team don’t include chest x rays or physical tests but instead following the treatment plan, reviewing how it worked, and adjusting it based on the results.
posted by openhearted at 5:36 PM on December 1, 2023 [1 favorite]