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Suggest Treatment For Cough, Cold And Wheezing
Question: Dear Dr.
Here is my sons health history. Please read and advice.
Stage -1: My son was perfectly fine when we lived in XXXXXXX (hot dry climate)
Stage-2: We moved to XXXXXXX (cold and dry weather and high on pollen) when he was 18 months and was surrounded by heavy construction dust and pollution. He started falling sick every alternate week (maximum frequency) or once a month (minimum frequency) with cough n cold which mostly progressed to wheeze. He was unable to attend a full week in school. He also had inflamed adenoids that made him snore and sleep open mouthed even in an elevated position. We used to nebulize him with asthalin and gave him flohale inhaler and montair LC for a month or so following a wheeze. We never gave him oral steroids.
Stage-3: When he turned 3.5 years, we moved to XXXXXXX ( hot and humid) in the month of May.
For one whole month he was episode free. Then he started school. He falls sick because of viral infections. starts with runny nose and progresses to cough and then to weeze He has taken antibiotics twice. During one of the worst episodes of coughing we took him to a pulmonologist. He immediately prescribed kidpred for a week and we gave him that. He prescribed Seroflo 125 (2 puffs morning and night) and Singular 4 mg daily. He has been on these meds since July 10th.
He still falls sick twice a month with cold and cough and if untreated with asthalin inhaler progresses to a wheeze. His night snoring and open mouth breathing has reduced significantly
Additional facts:
He has not gained weight. In fact he has lost weight ( from 16.5 to 15.8 Kg ) Height – no change
His recovery after falling sick is quick (1-3 days w/ asthalin support)
He is very active now compared to his stay in XXXXXXX
lungs X ray normal. blood work mostly normal except for Vit D deficiency and high IgE
My question:
I have a strong feeling that the seroflo inhaler is not helping him. The frequency of falling sick has not come down. Only the reason has changed from construction dust to viral infection. Do we need to continue seroflo (500 mg/day)?
Is it ok to taper down seroflo? If so how do we taper it off? The doctor seems against reducing this high dosage.
Here is my sons health history. Please read and advice.
Stage -1: My son was perfectly fine when we lived in XXXXXXX (hot dry climate)
Stage-2: We moved to XXXXXXX (cold and dry weather and high on pollen) when he was 18 months and was surrounded by heavy construction dust and pollution. He started falling sick every alternate week (maximum frequency) or once a month (minimum frequency) with cough n cold which mostly progressed to wheeze. He was unable to attend a full week in school. He also had inflamed adenoids that made him snore and sleep open mouthed even in an elevated position. We used to nebulize him with asthalin and gave him flohale inhaler and montair LC for a month or so following a wheeze. We never gave him oral steroids.
Stage-3: When he turned 3.5 years, we moved to XXXXXXX ( hot and humid) in the month of May.
For one whole month he was episode free. Then he started school. He falls sick because of viral infections. starts with runny nose and progresses to cough and then to weeze He has taken antibiotics twice. During one of the worst episodes of coughing we took him to a pulmonologist. He immediately prescribed kidpred for a week and we gave him that. He prescribed Seroflo 125 (2 puffs morning and night) and Singular 4 mg daily. He has been on these meds since July 10th.
He still falls sick twice a month with cold and cough and if untreated with asthalin inhaler progresses to a wheeze. His night snoring and open mouth breathing has reduced significantly
Additional facts:
He has not gained weight. In fact he has lost weight ( from 16.5 to 15.8 Kg ) Height – no change
His recovery after falling sick is quick (1-3 days w/ asthalin support)
He is very active now compared to his stay in XXXXXXX
lungs X ray normal. blood work mostly normal except for Vit D deficiency and high IgE
My question:
I have a strong feeling that the seroflo inhaler is not helping him. The frequency of falling sick has not come down. Only the reason has changed from construction dust to viral infection. Do we need to continue seroflo (500 mg/day)?
Is it ok to taper down seroflo? If so how do we taper it off? The doctor seems against reducing this high dosage.
Brief Answer:
TOO EARLY TO TAPER
Detailed Answer:
Hi
Thanks for writing to us.
Having gone through your sons history,
1. You need to continue seroflo, this high dose is necessary to achieve control. Dont worry it is in the safe range.
2. Tapering can be done only if your son's symptoms decrease and remains without wheeze for atleast 6 months .
3. Need Specific allergy testing to find his etiologies for allergy . Once the trigger factors are identified , avoidance of the triggers along with inhalers will bring much needed control, WHICH WILL BE FASTER WHEN COMPARED BY TAKING INHALERS ALONE.
Many of my patients have benefitted from allergen testing and it is the scientific test for allergy.
4. taking flu vaccine every year will reduce his viral infections to a great extent, and inturn his wheezing episodes will go down in frequency.
Wishing your son good health
DR XXXXXXX
MD, FPCC, DAA
Certified by XXXXXXX Academy of Asthma, ALLERGY and IMMUNOLGY XXXXXXX
TOO EARLY TO TAPER
Detailed Answer:
Hi
Thanks for writing to us.
Having gone through your sons history,
1. You need to continue seroflo, this high dose is necessary to achieve control. Dont worry it is in the safe range.
2. Tapering can be done only if your son's symptoms decrease and remains without wheeze for atleast 6 months .
3. Need Specific allergy testing to find his etiologies for allergy . Once the trigger factors are identified , avoidance of the triggers along with inhalers will bring much needed control, WHICH WILL BE FASTER WHEN COMPARED BY TAKING INHALERS ALONE.
Many of my patients have benefitted from allergen testing and it is the scientific test for allergy.
4. taking flu vaccine every year will reduce his viral infections to a great extent, and inturn his wheezing episodes will go down in frequency.
Wishing your son good health
DR XXXXXXX
MD, FPCC, DAA
Certified by XXXXXXX Academy of Asthma, ALLERGY and IMMUNOLGY XXXXXXX
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Dr. XXXXXXX
Thanks for your response.
1. Although I understand Seroflo is necessary I would like to know what is the procedure to taper it off. Kindly give me the general taper down schedule.
2. How long do kids of 3-4 years typically take seroflo until they are off of it?
3. You mentioned allergy testing. I heard from my doctor that such testing is usually throws up inaccurate results. Everything from A to Z comes up as allergen especially considering his age. How do we avoid such false positives ? what kind of allergy testing do u refer your patients to?
Thanks for your response.
1. Although I understand Seroflo is necessary I would like to know what is the procedure to taper it off. Kindly give me the general taper down schedule.
2. How long do kids of 3-4 years typically take seroflo until they are off of it?
3. You mentioned allergy testing. I heard from my doctor that such testing is usually throws up inaccurate results. Everything from A to Z comes up as allergen especially considering his age. How do we avoid such false positives ? what kind of allergy testing do u refer your patients to?
Brief Answer:
Skin prick test or allergen specific IgE
Detailed Answer:
1. Tapering off example . Seroflo 2puffs----0---1puff for 3 months, 1puff---0---1puff for three months, then once daily for next three months , then alternate days for next 3 months and stop. At any point in tapering, if wheezing recurs , go back to previous one.
2. It may take 6 months to 2 years to achieve control.
3. Worldwide, allergen skin prick test ( done By allergy specialists ) OR allergen specific IgE is done for kids with allergy and wheezing to identify the triggers.
Cant understand why your doctor doesnt agree with this . It is the most scientific test. Many labs say they do such tests, but check if they do specific IgE for each item.
Regards
Skin prick test or allergen specific IgE
Detailed Answer:
1. Tapering off example . Seroflo 2puffs----0---1puff for 3 months, 1puff---0---1puff for three months, then once daily for next three months , then alternate days for next 3 months and stop. At any point in tapering, if wheezing recurs , go back to previous one.
2. It may take 6 months to 2 years to achieve control.
3. Worldwide, allergen skin prick test ( done By allergy specialists ) OR allergen specific IgE is done for kids with allergy and wheezing to identify the triggers.
Cant understand why your doctor doesnt agree with this . It is the most scientific test. Many labs say they do such tests, but check if they do specific IgE for each item.
Regards
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Dear Dr. XXXXXXX
I really appreciate your time for a detailed answer. We took your advice and took my son to an allergy specialist. He has ordered some blood tests for allergens now.
1. He has asked us to stop using seroflo and given an equivalent airtec. He said he does not recommend seroflo for kids younger than 6. Now I am really serious and want to know why. I had read the same on the manufacturers label. He said no need to taper too and just replace with airtec.
2. please give me a couple of labs in XXXXXXX that do skin prick test.
Thanks again
XXXX
I really appreciate your time for a detailed answer. We took your advice and took my son to an allergy specialist. He has ordered some blood tests for allergens now.
1. He has asked us to stop using seroflo and given an equivalent airtec. He said he does not recommend seroflo for kids younger than 6. Now I am really serious and want to know why. I had read the same on the manufacturers label. He said no need to taper too and just replace with airtec.
2. please give me a couple of labs in XXXXXXX that do skin prick test.
Thanks again
XXXX
Brief Answer:
seroflo is safe
Detailed Answer:
1. Seroflo is safe if given under supervision to kids/even infants.
Dont worry. Airtec or seroflo no issues, both are almost comparable.
2.I do it in my hospital , Neolife Childrens Hospital, Madipakkam.
Skin prick test needs proper technique, I dont think any lab does it well.
'Arun
seroflo is safe
Detailed Answer:
1. Seroflo is safe if given under supervision to kids/even infants.
Dont worry. Airtec or seroflo no issues, both are almost comparable.
2.I do it in my hospital , Neolife Childrens Hospital, Madipakkam.
Skin prick test needs proper technique, I dont think any lab does it well.
'Arun
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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