Opinion abut Advair for a 6 year old

[Loose rivets]

Is there a professional out there that has experience with and or any strong opinion abut Advair?

It has been prescribed for my 6 year old grandson, who, while certainly having what might be some sort of panic attack, has not IMO been satisfactorily diagnosed with asthma. One web page shows clearly that it is not normally prescribed to under 12s, though this may be for a specific dosage.

He had croupe a few months ago and was hospitalized for a few hours. Other than that he is bright, bouncy and generally full of life, until suddenly feeling he can't breath and that his heart is pounding. This happened in the gym once and as he entered the technology class today. Nowt in there but computers and perhaps a hint of ozone. (Room full of CRTs)

He ran, on and off, the mile home with Mrs R and me later today, with not the slightest shortness of breath or tendency to cough. He is however a chip off the old block, (once removed ) very analytical, and almost certainly too introspective for his own good.

His dad has considerable qualifications in mind / body interaction, but is torn between not wanting him to have this type of drug, against letting him have the drug to break a psychological loop. Right now, we are all biased towards him holding off the drug until we know more.

[got caught]

Its difficult to make a judgement without knowing your grandson's exact details.

In general terms, its fair to say that asthma is very difficult to diagnose in a 6yr old- they find it difficult to participate in the tests we need to do.

Its perfectly reasonable to adopt a "suck it and see" approach- try a medication and see what happens to the symptoms.

Having said that, our (UK) guidance wouldn't suggest advair as a first line treatment- has he tried a "bronchodilator" (eg salbutamol) first?

The components of advair are used very frequently in the uk, on children, and I personally havn't come across any untoward effects.


I think if your worried, express this to your doc, (they aint mind readers:-) ) and perhaps explore some further options, such as a "wait and see" approach.

[Loose rivets]

Thanks very much for that. It is somewhat reassuring should we decide to start the treatment. I say treatment, because it seems that the regime is preventative in nature.

I think that he may still have his 'puffer' from the previous illness, but I gather they are not to be used together. I'll check on that.

The problem down here in "the valley" (about as far south as you can get in Texas) is that the close relationship the we used to build up with our GPs at home, is very difficult to do here...and indeed, very expensive. Even with my son's medical insurance, there are always substantial amounts to pay.

Anyway, I will forward your reply to the child's father, at the end of the day it's his call.

R

[Flyin'Dutch']

As Got Caught wrote; the sort of combination medication like Advair is a fair bit up the step when it comes to treating asthma in children.

There are some diagnostic 'challenges' to overcome in kids as they can not do the spirometry tests we like to do to confirm diagnosis. However an experienced health care professional should have not too much trouble making a reasonable accurate working diagnosis.

The next thing is to get the parents/family on board as there is sometimes a fair bit of resistance on their part to accept that little Johnny has got asthma.

Good asthma control is paramount in all sufferers but more so in kids as un(der)treated asthma is not good for their physical/social and psychological development.

The 2005 guidelines from the British Thoracic Society can be found here:
http://www.enterpriseportal2.co.uk/filestore/bts/asthmaupdatenov05.pdf

As you can see long acting beta agonists come beyond the inhaled steroids.

Advair is a laba and steroid and should not be used before salbutamol and a low dose steroid has been tried.

And as fare as powdered inhalers are concerned (that are the diskus devices I see on the advair websites) they are not so good for kiddies either as they can't suck well enough at that age.

A puffer (mdi/pump or whatever they call them) and facemask/spacer is what you need for them. Not very flash or fashionable but it does get the stuff where it needs to work.

[Loose rivets]

FD, thanks very much for that. I will forward this info to his father tonight.

[Tarq57]

Try googling Buteyko, this is a breathing technique that has had a great deal of success in treatment/prevention of asthma. If the kid doesn't have asthma, it sure can't do any harm. If he does, it might mean steroid medications become unnecessary.
If he's had a panic attack, or prone to them, he might be hyperventilating. I learnt a bit about that on a stress course recently. It can lead to all sorts of unpleasant conditions. Like most symptoms of stress, the sufferer can be taught to manage them well so they don't progress to a chronic illness.

[Loose rivets]

Thanks again. will certainly read that through.