Michael Marcus MD Ped Pulmonary DrMDK
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Male: If a child is having an asthma attack, many times we give all corticosteroids. When and why do you select all corticosteroids over an inhalant? Dr. Marcus: If a patient is having an asthma attack, where his controller medications were not successful to prevent and his reliever medication his beta agonist, either Albuterol or Xopenex was not successfully relieving the symptoms, oral steroids would be the next step in therapy. Oral steroids are given in order to decrease the inflammation and acutely relieve that emergency piece of asthma, the difficulty breathing, the wheezing. These medications are very important rescue medications to prevent the more serious complications that can occur if the patient’s asthma is out of control. The important thing to remember is that when giving oral corticosteroids, more severe complications can occur. Given these medications from short periods of time will leave or prevent many of these complications and it is the long term use that is the most important problem. However, if the patient continually gets repeated short courses of oral corticosteroids, complications can still be seen. Male: And if a child is having some shallow breathing and gasping you don’t give oral corticosteroids, you go to the emergency room or call 911, is that true? Dr. Marcus: Absolutely. You should have plans on how to treat your child or yourself if your asthma symptoms develop. Your first step is to start with the beta agonist, your Albuterol or your Xopenex, whether you give it in a pump form or by a nebulizer, we should give it based on the instructions your doctor is giving you. If your symptoms do not get relieved promptly, then visiting your doctor or calling 911, or going immediately to the emergency room is important because it is only there that a full evaluation could be made and the proper therapy can then be instituted. Male: That is why sometimes when a school nurse or somebody outside the family sees a kid who is put in a very compromising position, not knowing the kid that well, and sometimes they try to do the right thing, it is a big delay when a kid is called acidotic and the all the medicine won’t work on acidosis, is that true? Dr. Marcus: This is very true. The school nurse is a very important part of our treatment team, yet she is in one of the most difficult positions because she is very limited in the resources that she has at her disposal. We frequently will give the nurse the ability of medication in school to relieve milder symptoms. However, I frequently do not allow a nurse to get more than a single dose. I would much rather that patient come to my office or if severe, go directly to the hospital, so that a more definitive and comprehensive therapy can be instituted. Remember, if your child is having asthma and it has been controlled and all of a sudden they are starting to have symptoms in school, it is very important to identify the cause of those symptoms and not merely treat those symptoms. If the nurse is giving the medication but there is no investigation as to what triggered the problem, the symptoms will inevitably come back over and over and over again. Male: Thank you very much.