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Q. Why does my daughter's asthma flare up even after Albuterol treatment?

Answered by
Dr. Amolkumar W. Diwan
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Feb 27, 2020

Hello doctor,

My 4-year-old daughter has asthma. She was diagnosed with a moderate asthma flare at urgent care four days ago. Flovent was increased to 88 mcg twice daily, Albuterol 2.5mg every four hours for 48 hours and Prednisolone 15mg/5ml one and a half tablespoon once daily for five days. She seems to be having retractions at night between 10 PM and 2 AM like clockwork. They are not severe as her respiration rate is 22-28, pulse oximeter reading is 96-98%. Pulse is elevated at times due to Albuterol and the highest recorded is 160 with no fever. She is tired and is pale in the face with dark circles under her eyes.

I followed up with the pediatrician yesterday and he diagnosed her with an ear infection and put her on Augmentin. He listened to her lungs and said they sounded fine. She had an Albuterol breathing treatment about one hour prior to her visit. These symptoms that comes on night are scary. Productive cough and the sound of occasional constriction in the throat causing a gag, with these mild subcostal retractions.

It is hard for me to determine do we go to the ER or not? It is hard to justify a trip to the ER with normal vitals and these sets of symptoms. Wanting suggestions regarding is my daughter on the right treatment? Could this be something other than ear infection and viral illness causing asthma flare? She has been sick with a stuffy nose, postnasal drip, and mild cough for three weeks. She is also taking Claritin, Singulair, OTC Tylenol or Ibuprofen for ear pain and Mucinex. I also have a video clip of these retractions and I am attaching it.

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Hello,

Welcome to icliniq.com.

As per your history, it is very clear that your daughter has asthma exacerbation. It can be because of an ear infection or viral infection in the airways. As you said in spite of antibiotics, oral steroids and frequent nebulization it is not under control. She needs urgent hospitalization to give her urgent care and to find out other problems if any. This flare up is a valid justification for her hospital admission.

As she is very young child she needs treatment under observation. The very fact that oral treatment being not effective. She needs intravenous drugs and steroid nebulization, x-ray and other blood tests. So I advise you to go to the hospital for admission without wasting much time.

This will help to recover her fast and find out the exact cause for her flare-up. Once she is settled and the acute problem is under control. She can continue with her inhaler medicines as advised. I think this explanation is enough for you to explain her situation to you.

I hope this helps.


The Probable causes:

Ear infection or viral infection.

Investigations to be done:

X-ray, blood tests.

Treatment plan:

IV antibiotics, steroid, and Levoalbuterol nebulization.


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