What other treatments help severe childhood asthma?

Question

Hello doctor,

My 8-year-old daughter has had asthma since she was three, but it has gotten much worse over the past six months, and I am terrified something serious is happening. She is using her Albuterol inhaler five to six times a day now and still wakes up coughing and wheezing almost every night.

Her pediatrician increased her Flovent to 220 mcg twice daily, but it does not seem to help much. She had to go to the ER twice last month because her oxygen saturation dropped to 89 percent, and her breathing was very labored. The doctors did a chest X-ray, which looked okay, but her peak flow readings are only about 60 percent of what they should be.

I have noticed that her asthma seems to get really bad right before I get my period each month, and someone told me that kids can be sensitive to their mothers’ hormones. She is missing a lot of school and cannot participate in PE class anymore, which makes her sad.

She has also been getting frequent sinus infections; she has already had four this year.

Could my hormonal changes be affecting her asthma somehow?

What else can we do to control these symptoms better?

Please help.

Thank you.

Answer 1

Hello,

Welcome back to icliniq.com.

I understand your concern.

What you described points out that your daughter’s asthma is very poorly controlled right now. This is not something that can be fixed by just adding a little more of her current inhaler. She needs her treatment plan stepped up and carefully supervised until she’s stable again.

At the moment, she is on a steroid-only inhaler, which is good but not strong enough by itself for the level of symptoms she is having. In her case, she should be moved to a combination inhaler that has both a steroid and a long-acting bronchodilator in the same device. That combination keeps the airways open all day and cuts down flare-ups much more effectively. The same inhaler can often be used for regular daily doses and also for relief when symptoms appear, so she does not have to rely on Albuterol so often. This switch alone usually makes a huge difference.

I would also give her a short course of oral steroids right now to calm the inflammation quickly and get her out of this bad phase. Every dose-both the controller and the reliever-should be taken through a spacer, and her inhaler technique needs to be checked carefully at each visit. A lot of kids get only half the medicine if the technique is not perfect.

Frequent sinus infections tell me her upper airways are also inflamed. A bit of warm, moist air or gentle steam can help soothe her nasal passages and loosen congestion when her sinuses are blocked. It makes the saline rinses and nasal steroid spray work better afterward. Make sure her room is free of dust, stuffed toys are washed or frozen weekly, no one smokes or vapes nearby, and the filters in air conditioners are cleaned regularly.

About the timing around your menstrual cycle. Your hormonal changes do not affect her asthma. What can matter is that your daughter is entering puberty, and her own hormones can make asthma worse just before her period once she starts cycling. Keep a simple diary of her symptoms and see if they rise and fall with her own cycle; if they do, the inhaler dose can be adjusted slightly during those days.

Once she is stable again, we all want to review her every few weeks until she is back to sleeping through the night and hardly ever needing her rescue inhaler. If she stays poorly controlled despite perfect technique and regular use. Then, there are now advanced treatments called biologics that can dramatically reduce attacks in kids who have allergic asthma.

I hope this helps.

Please follow up if you have any further concerns.

Thank you.