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

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.