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Asthma

Pneumonia and asthma

10/08/2008

Question:

Hello.

My 21 month old son, Andrew, has had Pneumonia 2 times within the past 2 months, where both times he was hospitalized for 3 days because his oxygen levels were low, especially at night. Andrew also had an episode last Winter where he was diagnosed with a bronchial infection.

The doctors have told us because he has had 3 episodes, they are diagnosing him with asmtha. Andrew has been prescribed Flovent, and we have a Nebulizer with Albuteral for when he starts to get a cough.

I have been searhing online for more answers because I just don`t seem to think he has asthma.

Can a person get asthma only when they have a cold? Andrew has never shown any signs of Asthma other than when he had Pneumonia.

Or can allergies cause a cold? Do you think we would be able to tell a difference of Andrew having a cold vs. him being allergic to our cat? He has a cough again now with a runny nose, but never has watery eyes around the cat or dog that we have. ( He will be seeing an allergist next week - just in case and for piece of mind)

I appreciate your answers. My husband and I are very concerned and confused about his health.

Thank you!

Answer:

The issue of "asthma" in young children is often a confusing one. In this age group, the symptoms of asthma (cough, difficulty breathing, and at times respiratory distress to the point of being unable to get enough oxygen) tend to occur primarily (and for some, only) in the setting of a viral respiratory infection - a cold. Since some viruses can, all by themselves, make a child have a wheezy chest (RSV is a famous one), there is often initially some uncertainty about whether the ONLY problem is an infection (pneumonia), OR if the illness is really a combination of an infection PLUS a lung that "overreacts " to the infection by constricting the airways, swelling up the airways, and making too much airway mucus - what happens in asthma.

Often, it's when a young child has repeatedly gone through this type of illness, and especially if the symptoms respond to asthma medicines like albuterol and steroids, that the diagnosis of asthma is made. Because asthma episodes can become dangerous (as your child's have - if he has required repeated hospitalization), coming to this diagnosis is a critical step in improving his health. It allows his physicians, and you, to start doing things in a preventive fashion to keep him from getting so sick. Administering medicine on a daily basis to calm down his airways (which, in asthma, are always irritated - even when he seems well) will decrease the chance that his next episode will be a "bad one." You will also know, next time, how important it is to start albuterol at the first sign of symptoms - and that if this isn't working, contacting your doc about starting oral steroids. This strategy can go a long way towards "nipping the attack in the bud."

In some young children, allergies can play a role in keeping asthmatic airways irritated and prone to the "overreacting" problem. This is especially true in infants/toddlers who have other signs of allergy - like ezcema. All by themselves, though, allergies don't cause colds, and certainly, unless they are setting off an asthma attack, they don't make it so hard to breath that your oxygen levels drop.

As I mentioned earlier, some young children only seem to have "asthma flares" when they get a cold. In the under 2 age group, a good portion of the children who have this pattern (especially if they don't have allergies, and don't have close family members who have a history of allergies or asthma) will "outgrow" their wheezing problems after a year or two. So the problems your son is having now have a good chance of getting better.

Meanwhile, though, it's important that he get good treatment to help him avoid any more serious illnesses. If he can stay well through this winter viral season, your doctor may discuss trying to stop his Flovent next spring . . . it will be important that you keep up regular appointments to discuss these sorts of changes. Likewise, your doctor will want to see him regularly to make sure the Flovent is working adequately, and that no additional medicines or testing are warranted. Be sure to ask your doctor to help clarify to you why he/she thinks your son has asthma. It's very important that docs and patients/families are on "the same wavelength" with this illness, so as a team they can give the best care to their child.

For more information:

Go to the Asthma health topic, where you can:

Response by:

Elizabeth D Allen, MD Elizabeth D Allen, MD
Clinical Associate Professor of Pediatrics
College of Medicine
The Ohio State University