My 9 year old son has wheezing problem. Suggest treatment

Question

Hello doctor,

My son is 9 year old and developed the problem of wheezing when he was 3 years old.

My father is asthmatic and I had wheezing when I was a kid (2-3 years of age).

We were residing in an area where the industrial pollution is very high and he used to get wheezing more frequently there.

In the less polluted parts, incidences of wheezing was much lesser.

We shifted to another city 3 years back and the city is highly polluted.

The weather here also is very erratic like dull, cloudy, occasional rains and sunny in between.

My son had several incidences of wheezing initially though it was never serious to get him admitted.

We have a nebulizer at home.

We used to give him asthalin before, but now it is either Levolin or Budecort or a mixture of both for nebulization when wheezing is bad.

My son was given Omnacortil forte syrup and tablet (10 mg - two tablets per day) for the first time last month.

The duration of medication was for 5 days.

This year the weather here has been very bad and hence incidences of wheezing have been higher.

As per the advice of the doctor, we give him Budecort 50 mg inhaler twice a day as a preventive measure (for 2-3 months in winter but this time in monsoon too) and Levolin inhaler two puffs each 3-4 times a day as and when needed.

We have been doing this for more than a year now.

This time during the period of wheezing, he complained of chest pain for the first time.

We noticed that when we gave him inhaler, the pain reduced.

The doctor told that it is related to wheezing and there is nothing to worry.

Still we got the chest x-ray done and he is fine.

But he regularly used to complain of the chest pain, especially when he stood for long in assemblies.

Sometimes we felt that he was making it up to draw attention/to escape studies.

Now the weather is warmer and he is fine and there is no trace of chest pain.

My younger son who is six years also has had wheezing instances but only 3 times during the past 3-4 years.

We also give him Budecort 50 mg inhaler now twice a day.

Please suggest a routine management for wheezing.

Secondly, should we try to find out any other possible heart problem for chest pain?

Thirdly, is it fine to give Budecort continuously/intermittently for 4-5 months in a year at a dosage of 100mg per day?

Answer 1

Hi,

Welcome to icliniq.com.

First of all, I am replying to your main 3 questions as follows:

1. Routine management of wheezing:

In my opinion, inhaled levosalbutamol (Levolin) is good for asthmatic wheezing. You can give it by nebulization or by inhalers (MDI - Metered Dose Inhaler) with spacer attached.

Personally I would prefer MDI with spacer for children more than 5 years of age because it is as good as nebulization and ensures maximum deposition of drug into the lungs (close to 90%) and easy to carry. Only important thing is that you have to ensure correct technique of using inhalers, which becomes very easy with the use of spacer.

Nebulization has problems of the equipment itself and also cross infections, especially as you have two children with wheezing.

In non-severe wheezing episodes, I usually suggest my patients 2 puffs (inhaler) at 10 minutes interval up to 3 times, if no improvement is observed, doctor may need to be consulted. For nebulization, I suggest 10 minute nebulization with levosalbutamol for 3 times, if no improvement, please consult a doctor.

2. Should we try to find out possible heart problem for chest pain?

I would like to mention here that an asthma episode itself can cause chest pain in children.

Also you said that chest pain improved with asthma inhaler.

Moreover, some drugs used for asthma like oral corticosteroids, theophyllines, etc., also can cause gastritis and chest pain.

You have also mentioned that chest X-ray is normal. So I would agree with your doctor that his chest pain is most likely due to asthma.

Were I treating your son, I would not suggest him heart evaluation. If he has additional symptoms of heart disease like swelling of feet, palpitations, giddiness and falls (syncope), unexplained perspiration, etc then only heart evaluation may be done.

3. Is it fine to give Budecort continuously/intermittently for 4-5 months a year at 100mg per day?

I want to clarify a few points here:

You have mentioned the dose of Budesonide ranging 50-100 mg (milligram), it must be mcg (microgram), I assume.
Budecort 100 mcg/day is a very low dose in my opinion. So if it can keep him free of symptoms, I would suggest you to continue with the same dose for long duration.
As you are giving Budecort via inhaler, it is very important for you to ensure that technique of your son is perfect. Also, please make sure he is shaking the inhaler every time before use and is rinsing his mouth every time after use, to minimize side effects.

Hope above information and suggestions will solve your queries. I would like to add further suggestions for both of your children:

I know that air pollution is a very big problem in cities. It is always desirable to use masks/helmet while moving into cities to protect lungs from air pollution.
If I were treating your sons, I would add Montelukast in their regular treatment. It will reduce requirements of inhalers and it works for both wheezing and nasal allergies.
I would also suggest both of them allergy testing. This will help you identify the substances they may be allergic to and also the measures to avoid them. Common allergies in children with asthma are allergies to house dust mites, cockroach proteins, indoor molds, pollens and pets.
I would suggest you to get your children trained in yoga and pranayama. This will help improve their immunity and lung capacity.
Please develop a habit of having foods rich in vitamins, minerals and antioxidants, i.e., plenty of green leafy vegetables, fruits, sprouts, etc. They improve immunity and also help body fight the ill effects of air pollution, etc.

Hope above suggestions will be helpful to both of your children.

For further queries consult a pulmonologist online --> https://www.icliniq.com/ask-a-doctor-online/pulmonologist

My 9 year old son has wheezing problem. Suggest treatment

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