So, I know this doesn't have anything to do with giftedness, or 2E, particularly, but I thought you guys might be able to help. My DD6 was recently diagnosed with asthma and we've been working quite hard the past 2 months to get it under control (a round of prednisone (3 days) along with 3-4 puffs of albuterol every 4 hours, then we went up to an inhaled steroid 2x a day and 4-6 puffs of albuterol every 3-4hrs) and it's finally getting a little better. Her primary symptom was just a nagging cough that wouldn't go away. Her x-ray showed lots of inflammation in her lungs, typical of asthma and the dr could hear wheezing in her lungs.

I'm trying to find good resources online to read up on asthma, but I can't find much that matches her symptoms. I really want to know what her chances are of having a full-on asthma 'attack' given the way she presented.

If anyone has any good resources, I'd love to know. Thanks guys!

http://www.sneezwheezdoc.com/education.html
These guys are great, they combine allergy expertise with asthma expertise, which I think is key.
They have us charting our peak flow measurements morning and night to really understand triggers, and watch stability.

Our ds had the nagging cough 'nuisance cough' someone called it...recurring sinus infections related to allergies and unexplained lethargy. Recovery after a cold took forever. Now things are looking up considerably.
We tried several inhalers before landing on one for daily use that works really well, combined with allergy med and flonase for histamine blocking. In addition to that, a fast acting inhaler for right before exercise or if symptoms flare up.

This page links to some articles/sites. Good luck!

Both of my sons have asthma - the oldest was severe when he was little. And asthma can greatly affect performance in school. If you're not getting enough oxygen, the brain just doesn't function as well.

Albuterol and steroids are good to stop an ongoing flare, but what you may want to ask your doctor about is adding a medication to prevent an attack. Every attack leaves scar tissue on the lungs, so prevention should be the goal. The oldest did well on Advair while the youngest has responded better to Singulair.

The "asthma cough" is the body trying to force air out through an inflamed airway. It is an indication that the asthma flare is not under control. We fought our insurance and got a portable, ultrasonic nebulizer and found that using nebs instead of puffs helped immensely. Nebs are far more effective than puffers, but insurance will try to keep you in a puffer since they're cheaper. We also used a stethoscope and O2 Saturation meter with the youngest since his 2E coordination issues make getting accurate readings impossible any other way.

DM me if you have more questions, I've done the whole all-night ER visits and other exciting things that come with managing asthma and am happy to share what worked and didn't work for me.

Tips that we've found helpful:

a) have a clear ACTION PLAN from your physician. That physician may need, especially initially, be a specialist in allergy/pulmonology. Finding out how to avoid triggers is KEY.

b) along with avoiding triggers... the single BIGGEST way to do that is to undertake whatever means necessary to avoid respiratory ILLNESSES. We are fanatics about handwashing-- our house rule is that it is the first thing you do after you empty your hands when you come into the house. We also fully vaccinate our entire household to the extent allowable under medical advice. This was very scary when my DD could not get a flu shot.

c) use a nebulizer for kids up to about eight... and thereafter, during illness, it's still just a really nice thing to have.

d) per our physician's advice, when we notice ANY signs of a flare starting... or possible onset of illness, even... we begin tracking peak flow numbers several times daily (as opposed to a few times a week) and as soon as they dip, we begin treating with a LABA-Steroid inhaler. This has actually made illness more-- well, more "normal." In other words, a cold doesn't leave her bedridden and limp for WEEKS the way it used to.

e) if triggers are aeroallergens, be AGGRESSIVE about avoidance, and if they are not easily avoidable... consider daily allergy medication. You're preserving lung function and preventing airway remodelling for the long term, which = lower lifetime steroid use. Win. Meds like cetirizine are really well-tolerated and very very safe. My daughter has been taking an adult dose (and sometimes more than that) since she was about three.

Good luck!!!

Oh-- and if you are limited to a metered dose inhaler, (and there will, flatly, be times when you are by virtue of simply not having your nebbie with you)...

use a SPACER. Way, way, WAY more effective.

My DD and I both have asthma.

I have two with asthma. I know that DS's situation won't apply to everyone but wanted to put it out there in case someone finds it helpful. My DS7 would get the nagging cough that wouldn't go away with every cold. Every infection triggered a month of the nebulizer. He also got strep at the drop of a hat. We finally got his tonsils and adenoids removed last winter. It has made a HUGE difference. He has been able to recover from "colds" in about a week with no month long neb ordeal. His asthma has improved significantly. The ENT and allergist theorized that he always had a low grade infection in his tonsils that contributed to systemic inflammation. Life has been so much better for him. He still has asthma but it is much more "normal" now.

We're an asthma family - sigh. Me, my brother, and my ds all have "the cough". My sister and mom have the typical wheezing. I think wheezing gets diagnosed much earlier. For us, my mom and sister have had more serious complications (hospitalizations, ambulances) but I think asthma is serious no matter. I'm interested in the resources given here also.

My sister has lung damage due to poorly treated asthma. We never NEVER go without a rescue inhaler (I'm spoiled because, even if I forget one...someone else in the family has theirs).

Crazily enough, my asthma had almost completely disappeared since having kids. My OB said 1/3 of asthmatics worsen with pregnancy (my poor sister), 1/3 stay the same, and the lucky 1/3 may find indefinite relief.

The thing I hate for my ds is how his meds change his moods - especially Singulair (and prednisone...eek). Luckily, my ds only needs bigtime meds in the spring.

Everyone has chimed in with great ideas and suggestions. One other thought: Google asthma and GERD (reflux). Research suggests a connection between the two, and the idea is that reflux can exacerbate asthma because the acid coming from the stomach while someone is sleeping can increase lung inflammation. If your DD has the nagging nighttime asthma cough you might want your DD to be evaluated for GERD as well. People with asthma are twice as likely to have GERD as well.

Indeed. My DW didn't even know she could experience asthma until she was nearly 30 years old and got her first dog. Understanding triggers is essential.


In avoiding respiratory illnesses, specifically upper respiratory infections (which are usually the first trigger to other problems), I cannot recommend a neti pot highly enough. I would typically experience 3-4 painfully severe sinus infections a year, and I began using one when I had a particular one that failed to respond to antibiotics. The neti pot helped me recover fairly quickly, and I haven't had a significant infection since.

For obvious reasons, I wouldn't recommend it to the little ones.

On another note... don't despair. Children outgrowing asthma is common, as the airways expand and become less likely to be blocked by inflammation. I experienced it myself... I was the kid who was regularly rushed to the ER at midnight, and my last attack was age 5. The military will accept applicants with an asthma history prior to age 13.

Yep...I'm dealing with a simple cold that is settling in my chest. I always end up on Advair for about a month after colds. We all get flu shots (and can't do the nose spray one tor risk of an attack).

I'm wondering, now, about getting a nebulizer for my ds...er only use the spacer. Hmmmmm....thanks for the input everyone.

Nighttime coughing can also be dustmite allergy. Just throwing that one out there.

One way to check is to:

a) put inexpensive encasements on mattress and pillows,
b) wash bedding in HOT water (and dry on the highest heat setting permissible),
c) stuffed/soft toys-- wash in a pillowcase, then stick them in a freezer for a few days, and this will both remove dustmite poo (the allergen) and kill the critters themselves.

If that helps significantly... then dustmite allergy is pretty likely. We wash bedding pretty frequently (at least weekly is advised for dustmite allergy).

What you describe sounds a bit like my older son's pattern, though you're describing only one repetition. He was diagnosed at 6 mos, though, yours is 6 yrs?

We had excellent results with a massive dose of beclomethasone maintained for a full year, and an allergy med. We avoided singulair b/c of serious side effects. He is now on a normal dose of bec, and the allergy med, and was able to be off bec out of asthma season.

The main thing I notice about your story is that it sounds like getting Complete control is a problem. You might need to overcall the meds for a while to truly end the current exacerbation, and then be able to go years barite the next. Ummm someone shoot the autocorrect. Anyway, rushing, but might be somewhat brittle asthma, pm me if you want, we have two cases brittle and one case "garden variety" in the family.

http://justnebulizers.com/micro-air-electronic-nebulizer-system-ne-u22v.html

The above is a link to the portable nebulizer we use. I did a lot of research and liked this one for its portability, the mask and mouth pieces, and that it used an AC adapter or AA batteries you can buy anywhere - even on vacation.

We were able to get our insurance to cover it under the Disability Act. If a puffer with a spacer does not provide a medically acceptable rescue, it can be argued that a regular neb limits the ability to live a full life (field trips, sports practices and competitions, etc. where electricity is not available. Plus the ultrasonic delivery is much more effective and speedy.

And, really, this is not that 'off topic'...check it out --
asthma+giftedness ---
Misdiagnosis And Dual Diagnoses Of Gifted Children And Adults: Adhd, Bipolar ...
By James T. Webb
Chapter 8

http://books.google.com/books?id=NQ...asthma%20linked%20to%20high%20iq&f=false

You guys are awesome. This is all very new to me.... The doctor hasn't done any tests or anything just yet. The nurse mentioned the spirometry test, but I am assuming he wants her asthma under control before doing that? They just sent me the paper work to get a blood test done for allergies (we don't currently know of any - hoping she's not allergic to the dog!) I'll be taking her to the lab place later this week.

Currently we are using a metered dose inhaler with a spacer, haven't done a nebulizer. At this point I have a nice long list of questions for the ped when we go after the allergy test!

Two with asthma here as well. (sigh) My oldest's, however, seems to be almost totally outgrown. DS's is less frequent but more severe when it happens. Both kids are triggered by illness.

epoh, be sure to REALLY discuss those test results. RAST values are notorious for producing false positives-- most often for food, but also for pet and pollen/mold allergies.

With food, it's easy enough to conduct a challenge to find out for sure-- but with the others, it's more hit and miss and depends a LOT on patient history. BEFORE you go into that appointment, be sure to arm yourself with a thumbnail journal of when your child seems to have the most trouble. That is, under what circumstances, both general (early fall until frost) and particular (at Jenny's house, where there are three cats and a parakeet).

If you have seen no evidence that your dog is a problem, then it (probably) isn't. A positive allergy test really doesn't mean much with respect to tolerating a particular animal, unfortunately.

So as in my example with dustmite allergy, it's more a matter of seeing whether or not efforts to reduce exposure to that allergen have any discernable impact. That will trump test results every time. You obviously don't want to find a new home for your dog just to "see" if it helps, though! Pay close attention next time you travel, though, to see whether or not you see improvement when away from the dog-- or worsening symptoms when you return home to your dog.

Spirometry is hard when a kid is impaired, but there's no real reason that I know of why a physician wouldn't want to check it as a baseline measurement.

You may want to check with your allergist whether dust mites are an issue in your area. When I raised it with our allergist, a national recognized expert from National Jewish Medical Center, he politely told me that dust mites are not an issue in Colorado because it is too dry here. He said that if we lived in Houston it would be a different story. I don't know whether dust mites live in N. Texas. You may want to check before going through dust mite mitigation.

Thanks for the info. I don't know about dust mites, but her mattress and pillow are in waterproof/allergen cases, so that should help if that was an issue. She does have some old carpet in her room, that we could remove (didn't have the money to do the whole house at once.)

We've always had a dog, and both sets of grandparents have dogs, as well as nearly all my siblings and husbands siblings, hah, so she's exposed all the time. She doesn't seem to cough much during the night, but the evenings and mornings do seem worse than the daytime. She coughs at school and at home... currently she's had this cough for going on 3 months. In the past we've seen the same thing, where she gets a cold and the cough would linger for a few months. She never had any other symptoms that we noticed, so it was always dismissed by us and the ped. We have a new ped, and happened to go in this time because we were going to visit a newborn baby and wanted to make sure she wasn't contagious.

It's been hard to track when her breathing seems worse/better, because she's 1) attention seeking and 2) six years old. LoL If we start talking about coughing, she starts coughing, 100% of the time!

That is where a peak flow meter is your friend. She can blow into it every day and it tells you an objective measure of her lung capacity. The peak flow will alert you when her lung function is below normal, probably before she can feel it herself.

I love me some data, so I'd love to be able to monitor that! That is on my list for the next appt.

FWIW, we were told DD was too young for a peak flow meter until she was...I think 7 or 8?

My DD8 has daily Zyrtec and Nasonex to control allergies with the option for nebulizer, Singulair and spacer+puffer as needed. Attacks are now rare and generally preceded by another upper respiratory illness or severe allergies. Getting rid of carpet was helpful. The dogs don't bother her. Going to homes with indoor cats is a problem. She does seem to be outgrowing it as she gets older. Ditto what everyone else said about getting flu shots and hand washing. Asthma specific checkups every 6 months with our pediatrician have been helpful for adjusting medications as needed over the years.

Hospital tip; if your kid does not wheeze, and is young enough, take off their shirt before triage. Indrawing around the ribs will get the message across even with nurses who sometimes just assume the blood gasses aren't working right ("oh, he's not at 86% oxygen, he'd be in more distress")

"Indrawing around the ribs" what does that look like?

Exactly what it sounds like;)... The skin between each rib is pulled in with each breath, so you can see the whole ribcage. It usually shows first in the little divet between the collar bones, when it gets a little worse, you can see it at the bottom of the ribs, and then everywhere.

DS can regularly be found running up and down the hallways asking incessant questions when he's in a state that would have most kids looking semi-comatose. I didn't realize just how odd it was until my second started having asthma attacks. Younger DS is a rag doll, or else asleep at 86%... Or was until he was about 4 mos. He hasn't had any significant attacks since then, but I suspect it's still true.


While I'm at it... OlderDS's first asthma attack lasted from three months until about 2 yrs 9 mos, and what we were calling attacks were just exacerbations of one single attack. Don't ignore a "happy wheezer" or a cough. Kids can adapt to amazing things, symptoms have to go away, or they can be self-perpetuating.

I can't overstate how important it was for us to get a respirologist. They're the ones who are going to suggest you try a peak-flow meter early, or write a note you can show the emerg dr. So you don't get sent home too early. Also, that's how our younger son got better treatment right off. Only th e resp. Was ok with prescribing meds at two mos. Not even the pediatric emerge dept was willing to treat him at all. we were just supposed to watch and wait... Like with our older kid. And the docs dont't realize how important the referral is because they think of asthma as basically benign (which is true, just that doesn't mean inadequate treatment is ok)

To add on to that, get to know what your child's breathing looks like when NOT having an attack. Otherwise it can be hard to know what you're looking at.

If your child has cough-variant asthma, though, you may not see this. O2 levels may also be fine. DD has CVA, and hers always were. However, her symptoms were extremely disruptive and incessant. DS wheezes and has low o2, but actually suffers less, because he responds to albuterol (she didn't) and doesn't cough all night.

Epoh - You asked what indrawing around the ribs looks like. It's called retractions, and it causes your child's rib cage to look like that of an emaciated child - skin sucked in between each rib and almost pulling up underneath the bottom rib. If you see this, it is an indication that your child is struggling to get enough oxygen into the lungs and is in distress. If you Google asthma and retraction you'll get sme images.

Another note from experience - peak flow meters are not always reliable in small children or children with motor coordination issues. In those cases, using a stethoscope to listen for the amount of flow going through the lungs (all the way to the bottom vs. only the top portion) and an O2 saturation meter are helpful. I

f your child gets mucous plugs, you can use a cupped hand to rhythmically beat in your child's back from lower lung to upper to help dislodge them - the same technique used for cystic fibrosis. Doing this is a warm shower will often help a child expel a mucous plug and get past a crisis.

Damage? Possibly.

Ask for a referral to a pediatric pulmonologist. There are so many other options beside Flovent (which is crazy expensive and didn't work for either of my kids), and a pulmonic it's will be much better equipped to make decisions about what combinations to try.

Flovent caused auful side effects for me, that's why my kids won't be on it until they can reliably describe these kinds of symptoms. Lots of other options, get a specialist. It's really worth it.

Michaela - Thank you so much! I looked after I posted my question and then tried to get DD to lift up her shirt and breath for me, of course that resulted in laughing and poking her belly out and running around giggling! I'll keep trying though. She is definitely very adaptive, her coughing does not slow her down one bit! I am hopefully going to make it to the lab tomorrow with her, and then when we meet back up with the Ped I'll ask about a respirologist. We don't actually need a referral for our insurance, but I like to get recommendations from the ped's office - they've been great so far. And this particular pediatrician I am loving a ton. The last pediatrician was the one who repeatedly dismissed my calls of concerns regarding lingering coughs, and who dismissed the idea that anything was wrong with my DS. Boo to her!