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Tuesday, May 21, 2013
Asthma or Systic Fibrosis
My daughter has been on a strict regimen of asthma medications and bolusters of prendizone. She is on servent discuss, flovent, singular, duravent, prendizone, and albuteral and intol aerosols avery 6 hours, feeling like she could use one 2 hours after she has taken her aersol. She says she feels like a 400lb person is sitting on her chest. She is 11 years old and was diagnosed asthmatic at 12 weeks old. She has lived on steriods for a good part of her life. Is there anything else we can do for her? She was tested for systicfibrosis when a baby that was negative. However, when she was 5 years old an ear, nose, and throat doctor was seen her for a second opinion and asked if she had systic fibrosis, because her lungs looked like she had it. Could she have it?
Asthma can, at times, be extremely difficult to manage. Even those patients with tight asthma control can experience breakthrough symptoms. Mainstays of asthma management include: 1. Avoidance of exacerbating factors such as dust, molds, pets, second hand cigarette smoke, pollens, pollution, to name a few. 2. Regular monitoring of peak expiratory flow rates. 3. A step plan of management that adjusts medications according to need. 4. Careful and consistent use of medications. 5. Careful and frequent follow-up by an experienced practitioner. The extensive array of medications outlined here suggests severe, intractable asthma. These are patients in which alternative diagnoses and complicating illnesses should be considered. Cystic fibrosis (CF) is one of several illnesses that can mimic asthma. Sweat chloride testing is the gold standard for CF diagnosis and should be performed at a CF Foundation accredited laboratory. Repeat testing may be considered if the initial results are in question. A positive test should be repeated to confirm the diagnosis of CF. Immune globulin deficiencies, structural abnormalities of the airway, and primary ciliary dyskinesis are just a few other causes of asthma-like symptoms that do not respond to standard asthma therapy. Furthermore, allergic rhinitis and post nasal drainage, along with gastro-esophageal reflux may exacerbate asthma symptoms. Often asthma control is not obtained until these influencing factors are reduced or eliminated. An experienced pediatric pulmonologist may be essential to the evaluation and management of intractable asthma.
Patricia Joseph, MS, MD
Associate Professor of Medicine
College of Medicine
University of Cincinnati