Can Asthma-Related Symptoms Develop Into Asthma?
- Monday, September 21, 2009, 13:47
- Asthma
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- Andrew:
- Joining us now, Dr. Gower, is Colleen from Norwich, New York. Colleen, thank you for being with us.
- Colleen:
- Hello.
- Andrew:
- I understand you have a 3-year-old child, and you’ve been told that your child has asthma-related symptoms. Tell us a little bit about that and then your question for Dr. Gower.
- Colleen:
- Okay. When he was a year old, he was hospitalized. He had pneumonia. And they diagnosed him there. They said he had asthma-related symptoms, that it wasn’t asthma, and they put him on Intal and Azmacort and albuterol when he got a cold. And he’s had that now for about two years, and he doesn’t wheeze when he runs. He doesn’t have any problems that you ever associate with asthma, except when he gets sick. When he gets a cold, it’s always worse. It turns to a sinus infection or an ear infection or bronchitis. And the inhalers have really done a lot of good keeping it under control, but I was just wondering, is that something that’s going to turn into asthma when he gets older? Is it really asthma now? Or, is that something that maybe I can do something now to prevent it from changing to something worse?
- Andrew:
- Good question. We were told that too, with our young child. It was – I forget what they called it, but restrictive airway syndrome, or something like that.
- Dr. Gower:
- Reversible airway disease. Bronchiolitis, bronchitis, respiratory syncytial virus. There are lots of terms.
- Andrew:
- So when is it asthma?
- Dr. Gower:
- Well, that’s a real gray zone. Is there a family history of allergy or asthma, Colleen?
- Colleen:
- I guess in my husband’s family there’s asthma.
- Dr. Gower:
- Okay. So there would be certainly a chance that your, is this a boy or a girl?
- Colleen:
- Boy.
- Dr. Gower:
- That he could develop into asthma or allergies or both. Allergies and asthma are related, and they’re hereditary. There’s certainly not a guarantee that he will have this, but if these symptoms appear at this age with that family history, the son has a higher than normal – across-the-board statistically – chance of getting asthma. At this point, upper respiratory infections are the trigger factor as I understand it, right?
- Colleen:
- Yes.
- Dr. Gower:
- Okay. How many times a year does this occur, approximately?
- Colleen:
- Well, they had him on the Intal at a lower dose, and it occurred a lot. It was every probably three weeks we were taking him to the doctor with some kind of infection. But since they raised it up to what it should be, it hasn’t been that much. It’s been like maybe once every two months or so.
- Dr. Gower:
- So, he’s taking it four times a day?
- Colleen:
- He’s taking it two times a day, four puffs a day.
- Dr. Gower:
- Four puffs, so that’s another way to do it. It probably doesn’t work quite as well, but he’s getting a full dose in. It’s not really a twelve-hour medicine, but that still is going to be a nice compromise, and it’s very difficult to get any medicine in four times a day. So, that’s great. I would do that. He’s doing that on a regular basis?
- Colleen:
- Every day, yeah.
- Dr. Gower:
- Okay. And Azmacort also, or not?
- Colleen:
- Azmacort when it starts turning into something, before it turns into an infection.
- Dr. Gower:
- Okay. So whether they’re calling it asthma now or not, they’re using the Intal on an every day basis, right?
- Colleen:
- Yes.
- Dr. Gower:
- Okay. So they’re really treating it as if it’s asthma or irritable lung disease right now, and there’s not a safer medicine out there than Intal, so I would suggest that you’re doing exactly the right thing. They’re hedging on the diagnosis because it’s very difficult at that age to make the diagnosis because you really can’t measure the lung function, and they’re doing everything right by getting more and more aggressive, depending upon if the previous treatment was adequate enough. I would suggest that you stay the course, and if not doing well, then start thinking about adding another thing, and that would be, again, as I mentioned, Singulair, which is a leukotriene modifier down to age two. And certainly, he’s three now, so it would be a different way to control the inflammation. Azmacort is an excellent anti-inflammatory cortisone, [it] doesn’t work real great if you use it acutely for emergencies because it just takes days to weeks to really reach full benefit.
But it doesn’t absorb into the bloodstream as much as prednisone or other systemic steroids do.
- Andrew:
- Dr. Gower at what age would Colleen, as a parent, know whether in fact this is asthma and would need to be managed long term.
- Dr. Gower:
- Generally, depending upon the personality of the youngster, it’s around four to five or four to six years of age when you could adequately measure the lung function to see if they have reversible airways disease, and can do a good pulmonary function test to show that it’s asthma or not. When in doubt, they’re doing exactly the right thing, and that’s treating it as if it’s asthma, but it’s not being called that at this point. One other thing, before I forget it, I would consider having somebody check a blood gamma globulin level, because you mentioned that he’s had pneumonia and sinus infections and ear infections. Now, we all get these occasionally. Certainly, youngsters get ear infections and sometimes sinus infections, and pneumonia certainly is there – if you have bronchospasm and asthma attacks you can also get a lot of mucus from the respiratory infection, but asthma itself produces a lot of mucus and then predisposes you to pneumonia.
So, if he’s had these things, one would wonder, is it just the twitchiness of the airways and the inflammation and the viruses that are triggering this, or does he have perhaps a low IgA or a low IgG antibody in his blood? So that’s an easy test to check.
- Andrew:
- Now, just so we understand the significance of that, if they check that and it is low, is that easily controlled? Or what happens then?
- Dr. Gower:
- Well, there are five different classes of antibodies. The IgE allergic antibody, which is frequently related to the allergic asthma or allergies or hives or food allergies; there’s the IgD, which we don’t really understand much about; and then there’s three classes that we typically measure under these circumstances when there’s a lot of infections. IgA, which protects the eyes, mucus membranes, respiratory tract, and the bowels. IgG and IgM which protect the interior of the body against bacteria. The IgA is really pretty commonly deficient, low, and it’s like one in 250 people who have allergies. Across the board, it’s about a hundred – one in 600 or 700 nationwide. You can’t really replace the IgA, but you’re more prone, and to give antibiotics if you have an IgA deficiency because you just don’t have enough defense out there to prevent the viral infections. You’re also more prone to push the person onto prophylactic medicines like the Intal on a regular basis and perhaps get flu shots and so on. The IgG can be replaced, so the one thing that you’re really looking for that you can really totally turn around is an IgG deficiency, because we can give infusions, injections, of the IgG to replace a deficient blood system.
- Andrew:
- Okay. So, Colleen, it’s just something worth looking into.
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