Tapering off Flovent and Decreasing Rescue Albuterol for Spring and Summer

Updated on May 10, 2014
H.L. asks from Washington, DC
7 answers


My nearly 3 year-old has viral-induced asthma (only displays asthma symptoms when sick with a cold). His action plan that he's been on pretty much for 7 months is 2 44mcg puffs of Flovent every day and 1 pill of 4mg Singulair every day. Then, at the very first sign of a cold, for 5 days straight we increase the Flovent to 2 puffs 2 times a day and administer 4-6 90mcg puffs of Albuterol every 4 hours. This has worked really well in managing his cold/viral-induced asthma.

I understand that the Flovent is preventative, daily med and the Albuterol is a rescue med which he only takes when sick with a cold.

When we first saw our asthma doctor, she said that we could take him off the meds in the spring some time and then start back up again in the fall. (After that appointment we starting seeing a different doctor in the same practice, but in a closer location. Bad idea. The first doctor was on the money and was very direct and confident with the action plan. The second doctor who we have seen twice now was very unsure and left most of the decision-making to me and advised I use a trial and error process to help guide me. My son suffered through some colds because we deviated from the original doctor's orders.) Anyhow, the original doctor doesn't have an open appointment until early July.

I just want to learn how and when other families start tapering their children who have viral-induced asthma off of Flovent and/or decrease or eliminate Albuterol for spring/summer seasons? Do you do it in spring or summer, when? Do you slowly decrease and for how long? Do you still use Albuterol during colds caught in spring and/or summer?

Many thanks!!

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answers from Washington DC on

Actually I don't agree with either. Flovent is a preventative medication used to reduce symptoms and prevent flare ups. Albuterol is a fast acting bronchodilator used for emergency. If there was going to be anything I would not use every day, it would be the albuterol. Flovent and Singular are fine to take daily. Although your child seems to have flare ups more seasonally, flu and colds can occur at any time. Respiratory illnesses are more difficult and challenging to treat in patients who have breathing issues. I know I'm not your doctor, but trust me on this. You would much rather be safe than have something happen to your child because it was during "off season".

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answers from Minneapolis on

I would try to talk to one of the doctors' nurses. My son, now 17, has viral-induced cough-variant asthma, but also seasonal allergies. We use the albuterol only as needed, but stay on the preventative (which would be Flovent) all year-round. You shouldn't need to taper albuterol since that is a rescue, as-needed med, but I wouldn't want to change the Flovent without a doctor's orders. That said, based on his action plan it does sound like you can definitely limit the Flovent use to 2 puffs once a day, but I would be concerned about eliminating it without doctor's instructions.

ETA: I see that I didn't fully answer your questions. My son uses albuterol all year, but only when he has symptoms and sometimes before exercise because he is an athlete. He probably uses it more than needed on occasion simply because he's in the habit of taking a puff when he takes his other meds.

He is on Flovent all year round, perhaps because he has those allergies in addition, but he has varied between twice and day and once a day. He has never been off of some sort of preventative, either Pulmicort, Advair or Flovent , since he began seeing a pulmonologist at age 4.

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answers from Honolulu on

You should see a pediatric Pulmonologist.
And because your current Pediatrician does not know what to do.

No one, can tell you exactly, what to do or how or when or per your son's, condition.
I have Asthma, since childhood.
I also have seasonal allergies.
But, per MY conditions, what I take and when and how much and per what season, is based on MY, condition. Even if I also, have Asthma and allergies like your son.
EACH person, reacts to, each medication differently. And what I use may not be a "fit" for your son and visa versa.

There are various, asthma medications. They are not all the same.
And each person is different.
My Mom who has asthma, per HER medications and frequency of taking it, is DIFFERENT, than me. And visa versa. So whatever her Doctor tells her per HER Asthma, is not the same, as me or my Doctor.
And, our triggers for our Asthma, is different. As well.

Flovent is a steroidal based medication.
Albuterol is not.
They both do different things and are used for different purposes.
So you need to know that.

I have never... "tapered" off of my Asthma medications. Per MY inhalers, there is no tapering off of it. I simply use it, when I need to, or as a preventative, in order to prevent or lessen extreme asthmatic symptoms. And/or, during colds.

I too, get WORSE with my Asthma, when/if I am sick. But my Asthma is not exclusive to it being only triggered by colds. I know, that.
I also take other allergy meds, as needed or IF needed.
What works for me, may not work for others or their conditions. My Mom takes Zyrtec. I hate Zyrtec, it does not work for me. I take Claritin. My Mom does not because that does not work for her.
And per any steroidal based medications... I don't have to take that... unless, my conditions has reached an extreme level already. But I don't take Flovent. Never have. I had other types of steroidal based medicine, per my Doctor and per my, conditions. If/when necessary.

So you see, what a person takes per medications, will vary, and per their conditions even if others may have the same conditions as your son.
There are a variety of inhalers/albuterol/asthma medications or allergy medications. And any combination of it, varies. Per each person.

Asthma and its triggers, vary per person.
And the management of it and the medications taken for it, will vary.

My Asthma, is not "seasonal" based.
I have never heard of it being seasonal based or using asthma medication according to the season.
I mean, a person can get sick and/or exacerbate their Asthma condition, any time during the year.

But, per "trial and error" process to handle your son's Asthma... that means, getting to KNOW... your son's Asthma condition, its triggers, and knowing WHEN.... you need to start using his asthma medicines as a preventative measure... when/if he gets sick and using it BEFORE it gets.... into a worsening sickness.
With Asthma, it can get really bad, really quick. So for example, whenever I get sick or SUSPECT... I am getting a cold.... I USE my Asthma medications already, as a preventative in order to prevent my getting a full blown asthma, attack. But I KNOW MY BODY... and its symptoms. So then, I can and do use my medications, when I KNOW I need to. But again, each person is different.

Your son is young to realize those things yet. So YOU... must learn that... so that you will know, WHEN to start having him take his asthma medicines.

Asthma medications are either preventative, as maintenance, or as an emergency situation already when it has reached acute... status.
And when that has happened with me, for example, i was put on corticosteroids.

So you also need to learn about the stages of Asthma can occur. By observing your son and asking him questions etc.

Also, the medication combinations that a person takes, (ie: your son takes Flovent and Albuterol and Singulair), can vary. It is not the exact SAME medication combinations, for everyone.
That is not the med combination I take, for example.
My meds are different.

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answers from Miami on

Can you go back to the first doctor? (Just wondering...) Seems to me that this would be your best bet, if you can...



answers from Washington DC on

My daughter also suffers from asthma induced by colds. We are lucky enough that we don't have to take flovent all the time. We just start it immediately upon the first symptoms of a cold and then continue for at least 5 days after visible symptoms subside. If she is coughing excessively we give her the albuterol. That's usually happens at sleep time and if she has been running around.

My understanding is that there are some kids that develop the asthma symptoms immediately upon getting a cold and those are the ones that need to take the flovent all the time. For us that wasn't the case, she would develop the asthma symptoms about 3 days after getting the cold so we had enough time to get the meds in her system if we started the flovent immediately upon getting a cold.

My daughter also has seasonal allergies and during that time we give her nasonex and when the pollen is extremely high we give her allegra. This approach works very well for us. Has your son been evaluated for environmental allergens?

I can highly recommend Dr. Heidi Isenberg-Feig. She is with Johns Hopkins Associates in North Bethesda. She is pragmatic and has a wonderful bed side manner. She has three kids of her own and can really relate the children.

Anyway, getting the testing done for the environmental allergens really helped us understand when we should start the nasonex and when we could safely take her off of it based on when pollen is released. She gave us this nifty chart that has the common allergens and then when they bloom throughout the year. Having said that I take it with a grain of salt because she's supposedly allergic to to things that I have never seen her exhibit a reaction to so paying attention to symptoms is key.

hths, good luck!



answers from New York on

My daughter had viral induced asthma. At the first sign of a cold started meds. Albuterol for sure. Can't remember what else if anything. It worked well. Never had her on daily meds if she did not need them



answers from Dallas on

I tend to agree with some of the other moms. My son has cough variant asthma and is allergic to just about everything that floats in the air or grows. His asthma can be triggered by allergies or illness. He is worse in the spring & fall but some of his worst attacks have been in the summer. My son takes Flovent, Singulair, and Zyrtec daily. He uses the rescue inhaler on an as needed basis. The Flovent is one time per day until he is having issues. At that time he ups it to 2x per day. This has worked for him for years. The problem with taking your child off the meds is what happens if he gets a summer cold ? And how long does it takes to start working when you reintroduce the meds in the fall ? Some ideas to ask your doctor.

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