Thursday, June 25, 2015

On asthma. Or pre-asthma. OK, sensitive lungs.

So, Callum has asthma, kind of, maybe. This is something we've known about for a long time... his sensitive lungs first made an appearance right before he turned one with his first case of bronchiolitis, and then again later that same year with his second case of bronchiolitis, which was when we first obtained an inhaler for him. At the time we were only using albuterol, which is acute treatment for asthma symptoms that are currently occurring such as wheezing, coughing, etc. (often called a rescue inhaler), and I actually don't remember at what point we added in the second inhaler, Qvar, which is a daily preventive corticosteroid that helps prevent asthma symptoms from occurring in the first place, but it's been awhile since we first started using it--I'd say at least two years.

(Side note: Callum's official diagnosis is still up in the air. His regular pediatrician, whom we love, calls it "sensitive lungs" and doesn't want to put a diagnosis on it yet because she thinks there's a good chance he'll grow out of it on his own. Another pediatrician at the practice whom we've seen for a couple of bronchiolitis-related sick visits says that the criteria for asthma are that he requires an inhaled corticosteroid--Qvar--as well as a rescue inhaler--albuterol--and as a result he does have it. Another doc at the practice has said that he at the very least is considered to have pre-asthma. It's all semantics, though. The reality doesn't change... he has sensitive lungs that require treatment and vigilance. He may end up with an official asthma diagnosis down the road, but not yet, but in the meantime, that's essentially what we're dealing with and that's how we refer to it ourselves.)

Anyway, neither of us really has experience with asthma and it took us a shamefully long time to realize how important the Qvar really is for Callum. The doctor told us to give it to him once a day, but we weren't great about it. We would forget frequently and not think it was a big deal. The thing about Qvar is that because it's preventive, and because Callum doesn't have asthma symptoms most of the time (only in response to illness, usually), its effect isn't obvious and in your face the way albuterol's is. So we wouldn't use it as often as we should have, nothing would happen, and we would remain lax about it. Then every time Callum got sick he would end up with a case of bronchiolitis, sometimes manageable with his inhaler, sometimes requiring a trip to the pediatrician for a bulk albuterol nebulizer treatment and a prescription for oral steroids, and we still didn't realize the connection to the inconsistent Qvar use.

Then! In August of last year, Callum caught the enterovirus that was going around--the one where the media was full of dire warnings specifically for parents of kids with asthma. It was a particularly nasty cold, and he did need his albuterol inhaler, but the inhaler was sufficient and he did not end up requiring additional meds or treatment. But then, in October, Callum got a pretty hardcore case of bronchiolitis that his albuterol inhaler could barely touch. We brought him into the pediatrician, where he required such a big bulk albuterol treatment that he actually threw up from the amount of albuterol in his system (evidently a common side effect of large amounts but not something we had ever experienced before). At that visit the doctor also told us that this was what they had been seeing with this enterovirus with asthmatic kids--a rebound illness a month or two later with a pretty severe lung reaction that required a lot of albuterol to manage. He sent us home with instructions to administer albuterol round the clock whether he was displaying symptoms or not, and to bump up the Qvar to twice a day and keep it that way for the rest of the winter. We went home and followed his instructions religiously, and have continued to administer the Qvar twice a day since then.

And you guys, it turned out that the Qvar has made a HUGE difference for Callum. Honestly I am embarrassed that we didn't realize before how much it would matter. He had a ton of colds this past winter, but he has hardly needed his albuterol at all, and he did not have a single sick visit to the doctor all winter. Contrast that with the previous winter, where our insurance claims history tells me that he went to the pediatrician to be treated for bronchiolitis four different times over a period of four months.

Qvar! It works! Follow your doctor's instructions, guys! You're welcome!

Seriously, though, this is like a magic drug for us. And actually, we have just sort of inadvertently proven that concept, because I was recently wondering if maybe it wasn't the Qvar, maybe it was a coincidence, maybe he's just outgrowing his asthma like his pediatrician has always said he might, but then, well, we put it to the test. When we got toward the spring, sometime around April I started wondering aloud to Torsten if maybe we should scale down to just one dose of Qvar per day since the doctor had said the two doses was just for the winter. Then Callum caught a cold, I figured it wasn't a good time, and I scrapped the plan.

Except... evidently I didn't adequately express my thought process to my co-parent, because Torsten somehow got the idea that Callum didn't need the Qvar at all anymore, not even once a day, and stopped giving it to him. So, he was still getting some, because I was giving it to him some days, but he wasn't getting nearly enough. And lo and behold, he got a cold, a super mild cold even, one that we barely noticed except that he was a little sniffly and Annika had a runny nose, and... now he has bronchiolitis. A mild-ish case, one that so far his albuterol inhaler can handle, but one that is far worse than anything he has had since before we started giving him Qvar regularly. He's coughing a lot, I can hear a wheeze in his breathing, and he needs his albuterol many times a day, including in the middle of the night. That's a situation that we haven't dealt with since the fallout from his enterovirus in October, and MAN did we ever get spoiled not having to deal with it. Now we're back in that place, and ugh, it sucks. Poor Callum is coughing and wheezing even though he's otherwise feeling fine, and we're both on edge listening out to see if he goes downhill and needs to be seen, and just, UGH. And I was so confused! I said to Torsten with great concern this morning that the Qvar doesn't seem to be doing the trick anymore because he got this bronchiolitis after such a mild cold after not having it all winter! And Torsten was like, "Um, I thought he didn't need the Qvar anymore?" And... LIGHT BULB MOMENT.

At least Torsten's guilt over having inadvertently caused his child to develop bronchiolitis will most certainly prevent him from ever making this mistake again. And I think we'll be sticking with Qvar twice daily year-round from now on. Clearly it helps. And clearly colds happen in the summer too. But it is so so good to know that the Qvar makes such a difference for him. With it, it's almost like has doesn't have asthma/sensitive lungs at all anymore. And that is an amazing feeling, for all of us.

1 comment:

  1. Aww poor Callum and his wee sensitive lungs! although MAN that is nice to have a medicine that works SO effectively. I feel like everything/anything I take is like, 80% effective at best. Sometimes it works great! Sometimes it's not enough! Who knows what today will be! So while the method of finding this out may have been.. uh.. non-ideal.. :) the results are pretty fantastic.