Irresponsible for Not Aggressively Treating Allergies and Mild Asthma?

Updated on November 05, 2012
C.T. asks from Carrollton, TX
29 answers

I recently took my 3.5 year old to an allergist to get help in identifying his eczema triggers. While there, she diagnosed him with asthma and proposed an aggressive plan for treating both his allergies and asthma (3X daily albuterol for 1 week, followed by daily fluticasone inhaler, and 2X daily fluticasone nose spray). I questioned (but didn't push) whether it was really necessary for him to take so much medication because I don't feel like either his allergies or asthma are severe. In fact, I'm not sure I agree with the asthma diagnosis at all. I try to minimally treat my own allergies and asthma, and I feel that using less medicine than the doctors recommend makes me feel better, overall. I was ready to follow the doctors instructions for my son, though, until I started reading all the possible side effects, and they aren't mild in my opinion -- looks like high rates of irritibility, nervousness, headache, dry mouth, and racing heart, possible slowed growth, and rare but more serious side effects. So, why treat when I don't feel like he really has a problem? He's not wheezing or gasping for breath, he just has coughing fits (which is the same way my asthma manifests).

So, what do you think? I plan to go ahead and fill the albuterol prescription, but just keep it in case of emergency. Does that seem irresponsible? Am I making the side effects out to be more than they are?

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So What Happened?

Thanks for the feedback; you've given me a lot to consider. I think I will take him into another doctor. Part of my hesitation over medicating is that I just don't really believe the diagnosis. I mean, I think there's a pretty good likelihood that he will develop asthma at some point in life, given our family history and his own history, but I'm not sure he really has it now. She did NOT hear any wheezing, and just heard mild coughing (she actually wrote no wheezing / no coughing on the chart), but made the diagnosis based on my description of his coughing over the past couple months combined with our family history and the fact that he's had bronchiolitis in the past. He has been coughing a lot over the past couple months but so has everyone in my family, as we've had at least 3 different viral illness in that time. Anyhow, she might be right, but I'll certainly feel better about it if another doctor comes to the same conclusion. Thanks!

*** I took him in to another doctor who also agreed, no question, that he has asthma. I had actually come to the same conclusion myself a day or two prior, because his coughing never did go away even after he was healthy and he got another respiratory infection that immediately flared into severe coughing. Anyway, this doctor was more responsive to my concerns and we agreed on an action plan that hits hard at the first sign of coughing but doesn't involve any medication on symptom-free days. Started on the meds last night, and my son already had his first night free of coughing. It may have taken me a while to get there, but I'm more comfortable with his diagnosis and plan now.

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answers from Chicago on

We went to the allergist two months ago. She put my daughter on an aggressive plan to treat a mold allergy (at the cost of 200 a month in medicine).

We tried it for a week, and then stopped. My daughter isn't complaining, she seems fine. In my book, you only take medicine if you absolutely need to. We just don't know the long term consequences of putting young people on these medicines.

With that said, asthma can be very serious.

I wonder if the nose spray companies are paying off these Dr's. Nose spray cost a small fortune! And I just can't believe it is really necessary!

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answers from Dallas on

I would say that if she diagnosed asthma she must have heard wheezing.
If he is wheezing, albuterol 3x a day for a week is pretty mild. Yes, it can make them shaky for a while after doing the tx and some kids get irritable but you really need to get on top of the wheezing. A week of it and you are done if the other stuff can prevent other attacks. Try it. The trouble with asthma, at least one of the troubles, is that once it starts it can flare up like a wild fire. Then it's really hard to control. It's not the side effects that you are blowing out of proportion, it's the asthma you are underestimating.
Long ago, and far away, before kids I worked as a Respiratory Therapist. I have seen the worst side effects of albuterol extremely rarely. I have seen the terrible effects of underestimating asthma, many times.

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answers from Seattle on

I would treat it but also try chiropractic and removing dairy and gluten from the diet, I know people who've recovered completely or were able to live with less medication for their asthma through this regimen.

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answers from Louisville on

Honestly, if I were you, I'd see a pulmonologist to treat asthma.

Asthma is nothing to fool around with. This year - well, within the last 5 months - I had 1 asthma patient in my ICU who became an organ donor. He was 15 and brain dead from an asthma attack. And I had a 4 year old who was on ECMO (heart lung bypass) for 11 days due to an asthma attack. Her patents took your approach - treat attacks with fast acting medicines, but no control medicines. Their daughter may never be "normal" due to the ECMO & brain damage from lack of oxygen - can you imagine their regret?

These 2 stand out due to their severity, but in the past 12 months, there have probably been well over 65 asthmatics in my ICU, roughly half requiring ventilators, and almost all with families non-compliant with their doctor's recommendations.

Asthma is a serious, life threatening disease.

Ease see a pulmonologist or get a second opinion if you aren't comfortable with your current treatment plan. But don't just plan on fast acting meds to save your kid. Sometimes, it's not enough.

10 moms found this helpful


answers from Dallas on

Asthma in Texas is no joke. Sounds like a good asthma plan to me. Coughing fits can turn serious real quick. I see it every day at my pediatric office. Research RAD and asthma and allergic rhinitis. There are wide effects to EVERYTHING. Most people don't experience them. Some do, but the outcome of not treating properly could be worse than when you first took him to the DR. And albuterol three times a day is not "that" aggressive.

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answers from Seattle on

Well... My son has severe asthma. A conservative treatment for him when things are kicking up is

Albuterol 4puffs every 4 hours round the clock
Inhaled fluticasone 2puffs (high dose) 2x daily
Oral steroids (pred or dex)

An aggressive treatment plan for him:

- 8 puffs albuterol every 30 minutes 24/7
- 4 puffs fluticasone 2x per day
- Oral steroids Daily (pred or dex, high dose)
- Supplemental oxygen
((5 weeks is the longest we've had to do this one, usually just 1-2 weeks)

.... So to ME, what you're describing is a very GENTLE treatment plan to get on top of a mild case... Not an aggressive one. My sons normal use w/ no problems is more than the treatment plan you've been given. So to me it sounds like this is a starter/trial to see how things go with a very relaxed regimen.

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answers from San Antonio on

I also live here in Texas...

When my son is coughing he is already in the yellow zone on his asthma alert/worksheet. The coughing tells me he is having a an asthma flare up. His coughing alerts me that we need to start the albuterol (the nebulizer seems to work much better...but we do have the inhaler too). Coughing means he is wheezing.

When we went to the son was put on zertec (once a day mornings), omnaris nasal spray (twice a day), flovent (twice a day), and benedryl (one a day evenings)...they tried singular, but it induced tantrums and so the switch to omnaris. (Oh and albuterol as needed depending on where he was on the worksheet...anywhere from a nebulizer every 3 to 4 hours around the clock to every six hours around the twice a day...or none). At this point he was having a major flare up every time he caught a cold/upper respiratory anything...which becasue of the old yucky carpet in his classroom and his severe allergy to dust mites, was monthly. We would end up in the pediatrician's office for hours on end getting breathing treatments or the er after hours to get the wheezing to stop.

I too was concerned about all the medications, but the allergist was very positive that once he finished that year in school (got away from the horrible reading rug (it was kinder) and lived a while in a dust mite free home (we have no carpet and his bed is sealed up tighter than grant's tomb)...we could stop medication over the coming summer and see how he did.

So we stopped medication come summer and unless he gets a cold or is exposed to dust mites we don't medicate except on an as needed basis...which comes and goes.

I am glad I medicated him with the full regimen of medication even though I was nervous about the side effects...I just watched carefully (hence catching the tantrums related to the singular).

But I know with my son the cough is a bad sign we could be headed towards the er if not quickly nipped in the bud. Good is hard to make all these calls...and if you are nervous get a second opinion, it couldn't hurt.

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answers from San Francisco on

I have cough variant asthma and have had it my whole life, so you should consider your son lucky if he is getting diagnosed early. It has absolutely negatively affected my life even though it is mild. Under treated asthma also has side effects (serious fatigue, irritability, and sleep deprivation to name a few). Get a second opinion if you must, but do NOT under treat. Children are often treated my aggressively as their risks can be very serious. I am sorry you are going through this. If it is any consolation, my son who had pneumonia at 4 months and then asthma, is getting to the point where is seems to be out growing it.

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answers from San Francisco on

If he is having a flare up, then getting it back under control is important. Once it is under control, then you can work with your doctor to scale back the medicine.

My son has asthma and if we do the daily maintenance/preventative medicine, his quality of life is a lot better than if we wait to respond to a flare up. He has fewer issues to begin with and any flare ups are shorter in length.

My son has mostly illness induced asthma. So during the fall and winter months, we do a once daily maintenance dose. If we see signs that he is getting sick, we bump it up to 2-3 times a day plus the albuterol equivalent as needed. In most cases, we do not even need the albuterol and if we follow this plan, he has no wheezing when sick and he doesn't have a long lingering cough after the illness. Before he was diagnosed and treated, he would frequently have 2 weeks of coughing after every illness. That means less sleep for him as the coughing keeps him awake...which just leads to him feeling even poorer.

So I've seen the improvements from properly treating asthma...both in my son and myself. I'm a big supporter of using daily maintenance medicine over waiting for flare ups and trying to fight it with an emergency inhaler type medicine like albuterol. Albuterol, in my experience, gives more of the racing heart, nervousness type side effects than the maintenance ones. So less of a need for albuterol is better both because of the side effects and because it means the person isn't getting into a bad enough state to need it.

I understand not wanting to take more than is needed. But it's worth getting into a good state first...then look into what you can scale back, without causing frequent flare ups.

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answers from Washington DC on

Hi C.,

I had a similar situation with my son too--at about the same age (just coughing, no wheezing, no other real symptoms). I think you are right on to lessen the amount of meds--we only use albuterol when necessary (which has been a few times in the last year and a half). My son does take over the counter claritin, Q-var and nose spray, but we only use all three daily when his allergies are bad (like this fall--it's been a bad allergy season). There are weeks when we use nothing, and our allergy doc understands my concern for over-medicating. Do what works for you and your son!

Good luck!

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answers from Honolulu on

**Adding this: If a person has Asthma, only a professional can accurately diagnose it, and whether or not it is a mild form or not. My Asthma is "mild"... BUT, there were many times, that I had had, emergency acute stages of it, too. AND there is no way, to predict that, if/when it does develop into a worse stage.
Not all inhalers, have those same side effects you noted. There are many types of inhalers. And each individual person, reacts differently to it. My Mom has an inhaler, that works for her. For me, I don't like it and have another type. For example.
My Mom, developed Asthma... later in life. BUT prior, she had had Bronchitis etc. and one time she didn't go to the Doctor to treat it right away, and now she has a scarred lung. Lung damage.

So, being your son is having coughing fits... I would seek another specialist, a Pulmonologist for example, and see WHY he is coughing so much. And whether or not it is Asthma.
It is not always good, to compare one's Asthma, to another person. Because each person, has it differently, and per acuteness which cannot be properly evaluated unless it is by a professional.
And if he does have Asthma, medication... is... necessary.
Untreated Asthma, can also create, other medical problems and emergencies. As, Riley J. noted below.

I have had Asthma since I was a kid.

As an Adult, I now know a lot more about MY asthma.
I don't use my meds everyday.

In children, Asthma can manifest or display, differently. Not in the conventional "wheezing" manner.

Each person's Asthma, is different.

Attacks can come on suddenly with no warning.
My Doc, said that people die from it. They didn't have their inhalers on them, or waited too long until going to the Doctor.

Now, you saw an Allergist.
Not a Pulmonologist.

Get a 2nd opinion as well.

I would, get an inhaler to keep on hand.
There are MANY different types of inhalers.
For maintenance or rescue types.
The side effects you listed... mostly occurs when the inhaler is given but is not used as directed. Because, a person can overdose with misuse of an inhaler too. That happened in my State, to a Tourist.

Again, get a 2nd opinion as well.

Asthma, is not just about wheezing or coughing or gasping for breath. By the time someone is gasping for breath anyway, it can be too late and they can die. Or their skin/lips/nails will be all blue. Because they are suffocating.
THE point is, a person with Asthma.... will have (especially in acute stages) inadequate Oxygen levels in their system and blood. And their chest will be sucking in, each time the take a breath. And by this time, it is in an acute stage.
Even having acute coughing fits.... can cause stress on the heart.

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answers from Pittsburgh on

Definitely get a second opinion. We had an allergist diagnosed my son with asthma - we went because we suspected allergies but not asthma. Tried a bunch of meds and none of them helped his cough, and that dr just kept trying additional asthma meds. Went to a new allergist who said the reason none of those meds are working is because he doesn't have asthma. He has allergies causing postnasal drip. That is irritating his throat causing the cough. So now we are on one very common allergy med (the fluticason nose spray once per day) that has everything under control. So, the lesson I learned is that you should trust your gut and that not all doctors are created equal.

I'm not suggesting that you ignore astha symptoms - I know someone who was hospitalized as a child for several days because of a severe asthma attack; he probably could have died if he hadn't gotten treatmetn soon enough. But if there is no wheezing or trouble breathing...

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answers from Los Angeles on

I would definitely see another doc. My son also has allergies (food) and mild asthma. We use albuterol only when needed (two puffs at a time). We do use Qvar once or twice a day as a preventative measure and have found that doing the Qvar does make a big difference in his overall health. If we ever stop using it for a few days, he starts wheezing on a daily basis. So we definitely think it helps him.

Is he actually using an inhaler as opposed to a nebulizer? I would seriously question that. Most kids under 5 are not able to properly use an inhaler and absorb the medicine much more effectively through a nebulizer. It's a pain in the neck, but it does make a difference.

When he's sick, we increase the doses. I don't necessarily think that what the doctor prescribed is over-medicating in general; however, you're right to think it might not be what your son needs based on his history.

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answers from Pittsburgh on

My allergist explained to me that asthma is not a disease but a symptom. Most often the underlying cause is allergies. If you treat the allergies you lose the symptom (asthma).

It sounds like the allergist is trying to get him undercontrol. Once everything is undercontrol you may be able to get him off some of the meds.

As for side effects, all drugs have side effects but not everyone encounters them. Why discount the medication before you know how they will effect your child? I'd be more worried about slowed growth because of not getting a proper breath than a slim to none side effect of a drug.

BTW when I was in high school I coughed for hours after I ran track. I was told I had exercise induced asthma and given an inhaler by my pediatrician. In my mid 20's I was finally diagnosed with allergies. I started receiving allergy injections which have brought my allergies under control. Today I can run without an issue and no inhaler. I asked my allergist if I had grown out of my exercise induced asthma. He said no that my allergies are under control. When I ran track I wasn't starting out at full lung capacity.

Has the allergist recommended injections? I have seen them make a HUGE difference in myself and my daughters. You may need the drugs in the beginning but if you go the injection route his immune system will get stronger and he probably won't need them. Plus the younger they are when they start the injections the quicker they respond. I never would have believed it but saw it with my daughter.

Good luck to you!

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answers from San Francisco on

Get a second and maybe a third opinion on your son's condition. You want to make the best decision for your son so get more information, and be at peace with the decision that you make.

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answers from Shreveport on

This is going to sound really odd and off the wall but another choice to consider is taking him to an ENT dr. My son's usual dr was pushing hard to dx him with asthma but I pushed back because it just didn't sit well with me. There is no history in either family and my gut was telling me it didn't make sense. He would have a cough at night that sounded just like whooping cough. No wheezing and considering he plays soccer and is extremely active outside there should have been more signs for me to accept that kind of dx.
So after much back and forth she agreed to send him to an ENT. That dr was a gift to us. He looked over my son and asked a few questions. Come to find out tonsils were enlarged as was his adenoid. Now I did have to agree to surgery which was worrisome but considering the side effects and life long impact of an asthma dx I agreed to the surgery. Low and behold the coughing and snoring stopped. About 2 weeks after he was all healed I happened to be walking past his room about midnight. I was so use to his snoring that when I didn't hear anything coming from his room I ran in there flipped on the light and woke him up to make sure he was ok.
He hasn't had the "whooping" like cough since then. That was 3 and half years ago. His original dr was surprised but happy she was wrong.

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answers from Dallas on

I didn't read your other responses, but good for you about being worried about the side effects! Doctors are trained to treat or symptoms with medicine, but what about treating the cause?

I ended up on seven different medicines for asthma/allergies and was getting pneumonia 3-4 times a year (listed as side effect on at least three of the meds). Now I see a natural doctor and treat it with 2mg of cortisol daily. Which doctors don't like me being on, but my asthma is controlled.

He may need the albuterol for emergency situations and allergy meds at certain times of the year which is fine, but treating the cause I believe is more important.

Search and visit health food stores. You can treat a lot naturally.

Good luck!!

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answers from Amarillo on

Go with your gut feelings. Know that your child does not have to present in the usual way to have asthma or bronchitis.

I just got out of the hospital after two days of treatments. I had a cold or such and went away and then drove home with the car window open and started sneezing and runny eye. Next day a flu shot sent me over the top. Home treatments and nebulizer did not help. My arrival to ER was via ambulance rather than car as I was gasping for air and could not sit normally.

So do get a second opinion and work from there.

Good luck to him and you. The listed side affects have happened and registered with the company. Not everyone is going to get everyone of them but might so they have to list as many as they can.

The other S.

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answers from San Francisco on

the side effects of those meds is like a dose of methamphetamine! I would take him to your nearest Children's Hospital along with all the meds for a second opinion! I always feel like the less meds you take routinely, the better they will work when you need them.

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answers from Oklahoma City on

Please ask the doc to prescribe Xophenex for his nebulizer instead of Albuterol. There are a lot less side effects to it for kids. They don't get so shaky and it's just a whole better experience for me when I see how if effects the kids.

It works the same as Albuterol but has way less side effects. I also add a vial of sterile water to the premixed vial of meds that you get in the silver pouch. It gives extra moisture and makes the cough so much easier to get up and out.

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answers from Spokane on

you never fully realize how bad their asthma is till you see them after a week of treatments. my daughters asthmatic (diagnosed at 10 months and showed first symptoms at 4 months). she would get 2 daily treatments a day with pulmicort (prevenative thats not used in children under 5 and my daughter started it at 10 months) and when sick she gets albuterol. the only side effect she got was being super hyper. she is 5 now and i slowly weaned her off her medication. i only use it when her allergies act up and when she has a cold.

my personal opinion is to go ahead with the week of treatments. see how he does. if you see improvement continue them. also you do not have to wheeze to be asthmatic! my daughter has wheezed once! in 5 1/2 years!!! when he has coughing fits thats his body having an asthma attack. just because he doesnt wheeze does not mean his air way isnt inflamed or saturated with mucous. think about the things you cant see and hear. also look at it this way breathing is kind of important.

also i have an old coworker whos son died from an asthma attack not because they didnt think he needed the medication but because they couldnt get the medication to him quick enough he was 8. that thought never leaves my mind to know my own child could die from a disease she has. i will always aggressively treat her asthma because breathing is too important.

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answers from Chicago on

I did not read the other answers but here is my experience with wheezing. Always listen to your gut! My son had bronchiolitis(RSV) last winter and I got too worried when his doctor told M. that he was wheezing(it's something I haven't dealt with before with anyone in our family). We started on albuterol and stopped the treatments when we felt he was doing better. I did 4 times a day for maybe 2 days, that's it.His doctor was totally ok with it , she said we need not use a nebulizer unless it's needed.
So after RSV , my son is at risk for wheezing with every cold. The next time he was wheezing, we really didn't know until we took him to the doctor. This time unfortunately my son's pediatrician wasn't available, so we had to see a different doctor. She said neb treatments 4 times a day for a week(yes a week!) and then gradually taper it off over the next week. I absolutely didn't want to medicate my son for so long. And my husband decided that he won't and we stopped neb treatments after 2 days as our son was not wheezing anymore. I was talking to a on-call nurse and mentioned this to her and she went crazy. She told M. that I should always do as prescribed by the doctor. In fact she told M. that wheezing can damage the lungs , so at the very first sign of a cold we should start with neb treatments, so that the cold doesn't reach his lungs. And stopping the treatment in 2 days was a mistake, and that we had already caused some damage by not continuing for a week. I was terrified I had harmed my son and cried a lot. We had an appointment with our pediatrician after few days, and I talked to her about this. And she told M. not to worry at all. She said I did the right thing, there is really no need to over medicate. And definitely no need to start neb treatment at the first sign of a cold. She asked for the nurse's name but sadly I didn't remember.
But yes , this advise might not hold good for asthma.I am not sure about that. But if its just wheezing you are concerned with then no, there is no need to over medicate. Our doctor asked us to use a neb for coughing fits though. And I remember she said if that happens very often with every cold, then that would be a diagnosis for asthma. You can get a second opinion about that.

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answers from Los Angeles on

When you get a second opinion, you should be clear about your concerns regarding the diagnosis and the medication. That way, the physician can either make modifications to address your concerns, or explain more clearly why what is being ordered is appropriate for your son.
Best of luck.

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answers from Dover on

You say they wanted to do the albuteral 3x a day for one guess that is to get it under control and then they would have him use it "as needed" so that does not sound aggressive to me. 3x a day every day indefinately would be aggressive.

I have allergy induced asthma and so does my daughter. So I do understand what you are dealing with.

My son and my husband do not have any such diagnosis but have both had to use an inhaler when they were sick. It helped w/ the coughing.

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answers from Washington DC on

wow, i'm with you. i do appreciate that some illnesses do need to be treated aggressively, but with such a little one i'd certainly want to start minimally and only ramp it up as needed.
i'd definitely get a second opinion.
the side effects are no joke. and the one they don't talk about is out there too. my son took allergy shots for years for his seasonal allergies. he still has the seasonal allergies, and has developed some food allergies too. would it have happened anyway? who can say? but i do know that shortly after we reported this, a sign went up in the office asking that all patients who developed food allergies after the treatment began to let them know.
are you using local honey?

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answers from Dallas on

My son a long time ago had the same diagnosis. I didn't want to believe it either and it turns out he's fine. At night when the coughing episodes would start I would give him a concoction of apple cider vinegar, apple juice, and honey. Did it religiously! The took him back and he went from a D to an A. The doctor was so shocked that he had I proved so much in a short time. When I told her I never given him any of the meds that we spent $300 on, she literally kicked me out of her office. Also, I took my son out of public school and he hasn't been sick since.

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answers from Eugene on

Some of the asthma meds take a while to become effective. This might be why the dr. wants to start treating now, before it gets out of control. However, since the side effects can be serious and your son's asthma is mild, I'd get a second opinion to create a treatment plan you are comfortable with.

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answers from San Francisco on

Well how do you know there will be side effects in your son until you try it?
If he handles it well and it makes him feel better, great.
If it has the side effects you're worried about just stop giving it to him.



answers from Tyler on

Hey -
My son has had asthma since he was a baby. My doctor's actually told me that they don't "officially" diagnose it until they are 4-6 when they can do the lung capacity breathing test. They have no actually done this on my son (he's 9 now), because he continues to exhibit all of the symptoms and he really does have it. When he was really small (2-3), when went to a pediatric pulmonary specialist to get it under control. They answered all of my questions and really helped me feel better about the drugs they were giving my son (provided me with journal of science studies that answered my questions).

My son was very severely asthmatic as a child and I can promise you, there were plenty of nights when I prayed he would just live through the night. For us, he mostly had the wheezing/difficulty breathing/coughing. However, when he was about 6, he started "just coughing". I took him to the doctor and they said he was having an asthma attack. This was the first time he had ever had an asthma attack that did not also include wheezing, so that was eye opening for me.

I highly recommend that you go and see someone and get all of your questions answered. The pulmonary specialist that we saw said that asthma, allergies, and eczema all are on the same gene, so people often have to deal with all three (my son does).

Also, my daughter has asthma as well (not as bad as my son). But one time, she was so sick (pneumonia) that she was not wheezing. The doctor said that her lungs were so full of fluid that the little sacs could not cause the wheeze sound. But, pneumonia is very serious. Please consider researching more and hearing more about the disease.

I agree with what another poster said - my son does better on Xopenex than pure alburol as well. But, on the other hand, my son DOES NOT get the hyperactivity associated with albuterol (thank goodness). Insurance covers Xoponex and albuterol differently (they pay less for Xoponex for me). So, think about all of those things as well.

Good luck,

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