Treating Asthma at Age 3

I recently took Marino to the pulminologist to get a plan for this cold/flu season. We generally start a proactive prevention plan in September to get ahead of any viruses, since Marino's asthma only becomes problematic with illness (there are other times he is coughing/wheezing, but it doesn't slow him down).

Now that he is a little older, the doctor wanted to make some changes. The end goal is to have him not need oral steroids to control his asthma, even with an illness. Last year, he needed oral steroids 6 + times to get his breathing under control, and the pulminologist is not satisfied with that. So, instead of using a nebulizer to deliver asthma medication, we're now using an inhaler with a spacer. The spacer has a small mask, similar to the nebulizer mask, but without the ventilation holes. We spray one puff of the medicine (albuterol) into the spacer, and we need Marino to breathe in 6 times, let him take a break and repeat. We currently do this twice a day, unless he's sick, at which point we up it to 4 puffs 3 times a day and add in the breathing treatments via the nebulizer. Here is Marino and my mom using the spacer.


In case anyone is curious, our insurance covered the cost of the spacer/mask, but they run around $30 - significantly cheaper than a nebulizer.

We've also moved on to the chewable form of Singulair. Marino loves these and always asks for a second. This is also a lot easier to manage than the Singulair granules.

It remains to be seen if the changes will make a difference. He currently has his first cold/cough of the season and it hasn't gotten any worse since we stepped up the number of treatments. I have to say, the spacer is about a million times easier to use, quicker and doesn't require electricity, so we can use it anywhere.

Fall Festival at Butler's Orchard

Hopefully this is not the beginning of a pattern this Fall, but Marino was sick again last week. Of course, his asthma makes a simple cold into a serious breathing issue and he went from a stuffy nose Thursday to wheezing and struggling to breathe on Friday. The pediatrician gave him prednisone and we went back to round the clock breathing treatments (Albuterol q4 and Pulmicort twice a day). Thankfully, prednisone works quickly to help the boy breathe, but it doesn't come without side effects, primarily a dark cloud hanging over Marino's head while he's taking it.

We were brave and took him to the Fall Festival at Butler's Orchard. We had fun, but there were definately some crabby moments as well. My friend Robyn, her husband James and son Ryan met us there, as did Ishmael, Sandra and Anthony and Jen, Matt, Sydney, Justin and Noah. We had a gorgeous fall day to pick pumkins!

As always, he loved riding the big slides with Daddy.

Pointing out pumpkins on the hayride. Remember last year he called them "papples"? Now they are "pumpkins". He's so grown up!
Eating carmel apples - he loved them, of course!

Ryan loves them, too!

Robyn, Ryan and James (they are expecting again in March)

Anthony and Ishmael, riding the tractor trikes

Jumping in the hay barn with Daddy

Picking out a pumpkin

Noah, Jen and Sydney (who is always willing to pose for a picture; I just love her!)

Jen trying on Marino's pumpkin hat

Sydney trying it on, too (Marino refused to wear it for me).

Marino wanted every pumpkin he found!

Sweet Sydney

They look so grown up pushing this wagon and pointing out pumpkins!

Ryan found lots of pumpkins he liked, too.

Visit to Pulminologist...Asthma Update

For those of you who read this blog or know anything about Marino, you know that Marino's asthma is a big source of frustration and stress for us. It is very difficult to watch your child struggle to breathe, and Marino's viral triggered asthma has meant a lot of minor viruses lately have turned into big illnesses, which in turn has meant lots of stress, money, time off of work for Evan and I, etc. In a nutshell, asthma sucks.

We took Marino to see a Pulminologist today, just to see if there was something different we should we doing to treat his asthma, or if he thought there was a larger issue we were missing.

Right now we are doing (if he is healthy):
Singulair once daily
Pulmicort nebulizer treatment (.25mg) once daily

*for those of you not familiar, both of those medications are medications intended to prevent asthma flare ups, not to control acute asthma attacks/flare ups.

if he gets any sort of cold or seems to be having more trouble, we add in:
an additional Pulmicort nebulizer treatment
Albuterol (2.5mg) every 4 hours (unlike Pulmicort, Albuterol is used to control asthma attacks/flare ups, its is not a maintence medication)

if that doesn't work, we've added in oral steroids (prednisone).

The Pulminologist listened to Marino's lungs and said he certainly thinks the asthma diagnosis is correct. In listening to his breathing for several minutes (for which Marino miraculously sat still and completely quiet), he could detect 1 wheeze per every 10 breaths and this is even with our current system of medicating the asthma (and he's not currently sick). He thinks that his asthma is probably less a result of his prematurity (given that he did not have breathing issues after leaving the NICU until he was 9 months old) and more a result of heredity (Marino's half-brother, Quintyn, had severe asthma as a toddler, too). He said we can hope he will outgrow it, but not to get our hopes up about that...he thinks we will likely be dealing with respiratory issues every winter and hopefully have easier summers (when there are less viruses to contend with).

I asked if he thought I should stop taking Marino to public places, since he ALWAYS seems to get sick within 72 hours after we take him to a place where he is exposed to many people. He said he didn't see any value in that, given that Marino is in daycare, and therefore already exposed to many people, who are exposed to many other people, etc. He made a wonderful point that the harm caused by the viruses he picks up in those places is balenced by the social benefit of being exposed to new people, places and experiences. I think this may be especially true for Marino, who is such a social boy.

He did recommend that we increase Marino's Pulmicort treatments, both the dosage (from .25 to .5mg)and increase to twice a day. We also got a fancy new mask for his nebulizer, that the doctor says he finds does a better job of getting the medicine directly to the lungs (especially with toddlers who are not all that compliant with a nebulizer...unless you bribe them with Yo Gabba Gabba). The new mask is called a Pari mask.

Here's a picture of what our old nebulizer mask looked like. As you can see, it has fairly large ventilation holes and is made out of a thick plastic.

This is our super cool new pari mask. It has smaller ventilation holes and is made of a softer plastic, so it conforms more to his face, for a tighter fit. AND it looks like a fish, which makes it about 12,000 times cooler, right?

Instead of unscrewing the top to put the medicine in, the pari mask is like a pitcher, so you pour the medicine inside. The other mask had actually become an issue in this regard lately, since Marino would sometimes pull the top off of the other mask, and meds would spew out. Not possible with Mr. Fish.
And here's what it looks like on. It also dispenses the medicine quicker and more effectively. The total time needed for this mask is 6 minutes. With our old mask, it could take up to 15 minutes to finish the meds.
We go back in 2 months (at the end of cold/flu season) to reassess where we are with our med dosages, and we may be able to cut back some in the spring/summer months.