How to treat asthma and allergic rhinitis in a 12-year-old?

Question

Hello doctor,

My daughter is 12 years old. She has uncontrolled asthma and has been really tough to manage. It seems like the smallest things trigger her attacks: dust, smoke, and even some smells. We live in the city, and her doctor mentioned that the poor air quality might be a big part of the problem. I am wondering if we should seriously consider moving somewhere with cleaner air, or if there are better treatment options we have not tried yet. I just want her to be able to breathe easier without us having to uproot everything. It is stressful seeing her struggle, and we have tried different medications, but nothing seems to fully control it. Is a change of environment really our best option?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

As you already described, your daughter is suffering from uncontrolled bronchial asthma and allergic rhinitis.

The key to the treatment of asthma is the use of inhaled medications. For adequate asthma control, appropriate inhalers with the right dose are to be used with adequate technique, and it should be used regularly.

Investigations to be done on newly diagnosed or uncontrolled bronchial asthma, if not already done:

Complete blood count.
Serum total IgE.
Chest X-ray.
Pulmonary function test (spirometry pre and post bronchodilator).

Causes for repeated exacerbations include:

Presence of comorbid conditions like allergic rhinitis, GERD (gastroesophageal respiratory disease), and obesity.
Incorrect inhaler technique or if the inhaler is not being used regularly.
If incorrect inhaled medicines are being used.

The following advice is to be followed if bronchial asthma is diagnosed:

Regularly start using inhalers such as Formoterol and Budesonide, one puff twice daily with a spacer, followed by mouthwash. Since she is older than 12 years, she shall use an adult inhaler in appropriate doses, as I already mentioned. Inhalers are to be used on a daily basis without any break for at least six months. No dose is to be skipped unless advised by a pulmonologist.
Mac spacer (it is to be attached to an inhaler; the technique of its usage can be learned through online videos).
Consult a pulmonologist either physically or virtually on a regular basis (at least once monthly).
Take vaccinations appropriate for the age if not taken already.
Control of co-morbid conditions, if any.
Wear a mask while you are going to polluted spaces.
You can use air purifiers at home to reduce allergens and pollutants. Keeping windows closed during high pollution days can help too.
Regular cleaning of mattresses, pillows, bed sheets, and pillow covers is essential.

Get all the investigations and follow up after one week with investigations, and then evaluate if her asthma is controlled or not and if it requires any further kind of treatment.

I hope this has helped you. Please feel free to reach me again, in case of further queries.

Thank you.