What asthma meds to give besides inhaler and nebulizer?

Question

Hello doctor,

My son is 13 years old. Since he was five years old, he has been suffering from asthma whenever there is a season change during March/April and October, during which he generally starts getting an allergic cold. I used to give him an Asthalin inhaler, but for the last four to five years, he has been using a Levolin inhaler to resolve the attack. Lately, I have started nebulizing him at home using 0.63 mg Levolin respule morning and evening and an inhaler several times during the day.

I have also started giving 0.5 mg Budecort respule along with that recently, as his asthma has not been under control for almost 1.5 weeks now. He wakes up in the middle of the night after two hours of nebulization and complains of feeling breathless. He needs to take multiple puffs using the inhaler, sometimes much more than the prescribed dose, as mentioned in the medicine leaflet.

I have been trying to get him to inhale steam, which gives him temporary relief. He is breathless when he wakes up at 6:00 in the morning, and he even missed school two days last week. I need your help to advise me on the right dosage of inhaler and nebulization to get the asthma attack under control.

Do you suggest any other medicines? I definitely would want to avoid oral steroids or any strong medicines.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

It seems your son is suffering from bronchial asthma. It is known to aggravate with seasonal changes.

You need to understand that by nebulizing him regularly, he will get dependent on nebulizers.

In my opinion, he should be nebulized with the doses you are already doing, only in case of an acute attack or suffering from asthma symptoms.

You can also add 400mg oral Doxofylline twice a day for a better response.

He might also require antibiotics like Augmentin for a short course.

Add a combination of Levocetirizine and Montelukast to him.

I also prescribe to my patients bronchodilator syrups like Bromohexine.

Once the acute attack settles, which usually takes five to seven days, he should be weaned off nebulizers.

He should be given Rotahalers like Formonide 400 twice a day.

And anti-histaminics like Levocetirizine should continue.

If he is asymptomatic, you should reduce the dosage of Formonide to once a day.

You should share my opinion with your treating doctor before you act upon it.

Revert back to a pulmonologist online for further follow-up.

I hope this helps you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I really cannot comment on any doctor's prescription.

But yes, I also find the dose quite high. For better help, mention his weight and current status.

Revert back with the anthropometric details to a pulmonologist online.

I hope this helps you.

Thank you.