Has he been taught proper inhaler technique by the doctor or a nurse educator? Could be he's not inhaling at the right moment, and hence the Xopenex isn't getting to his lungs (or not enough of it, anyway). Maybe having him re-taught would solve the problem.
Does he use a spacer? Sometimes that will help for younger kids. Even my 16 year old still uses a spacer. Using a spacer would be worth trying. Sometimes pediatricians' offices will give them to you for free. And if he used a spacer for his Flovent, too, he'd be getting more of the med in his lungs, which would help prevent attacks better.
It might be worth trying an albuterol inhaler. You're right, we all react differently to medications and sometimes it takes some trial and error to find the one that works best for a particular person. He could expect more jitteriness from albuterol, though, since Xopenex (levalbuterol) has been "purified" to remove that albuterol side effect. If not albuterol, then I think MaxAir (pirbuterol) is still being manufactured so might be worth a try.
Hopefully these ideas help you figure out what to do. Take care & good luck. JudyView Thread
He's 17, so he was last allergy tested a pretty long time ago. Allergies are known to develop during adolescence, so it would be a good idea to get him tested again (skin tests & intradermals, not blood tests) by a board certified allergist. And people who already have some type of allergic disease, like asthma, are prone to developing other types of allergic disease, like allergies or eczema.
When my allergies were at their worst (years ago), during my allergy seasons if I exposed myself to a lot of pollen or mold, I would get so exhausted I would have to sleep for hours to recover. Luckily due to good medications and years of allergy shots, those days are over.
Hope these thoughts help. Take care & good luck. JudyView Thread
I agree with Sonya; call your doctor and get guidance. It might also be a good idea to get a prescription of prednisone in case things go downhill. Then you will be reassured that you have what you need to avoid problems.
I don't think there's any hard and fast rule about asthmatics having to avoid a certain high altitude. In fact, I recall some fairly old studies showing improvement of asthma in children who were sent to the Swiss Alps for treatment.
Personally, I do suffer from altitude sickness, but that was something that predated my asthma. Thus, I know I'm going to have problems when I travel to places like Denver where it's a lot higher elevation than where I live. I take things slow, take ibuprofen for the inevitable headache, drink lots of (non-alcoholic) fluids, and get plenty of rest. I also cut back on exercise temporarily.
Hope some of these thoughts help. If you could take all the precautions you can ahead of time you'll probably lessen your stress and be able to enjoy the trip more. Take care & good luck. JudyView Thread
I agree with Sonya but would go further -- if you can afford it, consider getting your son evaluated at Mayo Clinic. The care there would be at a higher level and a better evaluation than the care available in northern Minnesota, so maybe there are some tactics that Mayo can suggest that your normal providers can implement. Just a thought, hope it helps. Take care & good luck. JudyView Thread
Do you consult with an allergist for his asthma care? That would be essential. I wonder whether playing outside wearing an N 95 rated face mask would help.
If it's any comfort, when my son was diagnosed with asthma years ago the allergist put him on Flovent. Per his allergist Flovent is the one inhaled steroid that is best for kids because it has a very low systemic effect -- i.e., the medication almost completely stays in the lungs and doesn't have an effect on the rest of the body. An allergist could explain to you the long term effects, but usually the ability to breathe trumps any side effects unless they're serious.
I also wonder whether allergy shots (i.e., allergen immunotherapy) would help him in the long run. It would take 3-5 years to reach full effect, but desensitizing him to allergens would reduce his attacks and allow him more freedom in his life. I know the shots have worked very well for me.
Hopefully some of this helps you. Take care & good luck. JudyView Thread
Whatever kind of primary physician you pick, you should also have a pulmonologist to monitor your COPD. Pulmonologists are lung specialists and are best suited to take care of COPD. My mom had severe COPD for the last 8 years of her life and the pulmonologist was the best.
Hope these thoughts help. Take care & good luck.View Thread
I've had the FeNO test a couple of times at my allergist's. It's really easy, although you do have to do it fasting (so do it first thing in the morning before breakfast). Eating apparently mucks up the results.
FeNO stands for Fraction of Exhaled Nitric Oxide. (No, you do not inhale nitric oxide, you exhale it as a normal part of breathing.)
What this test does is to measure the amount of nitric oxide (NO) in your lungs, which is a marker of inflammation. The less NO, the better your lungs are doing. So yes, with the FeNO test the doctor would be measuring whether you were getting better and whether your ICS was doing a good job at reducing lung inflammation.
The test simply involves blowing into a little plastic machine for a specific amount of time -- maybe 30 seconds, or a minute. You have to keep the airflow going out at a certain rate. The gizmo my allergist has has a cloud icon and you have to blow to keep the cloud in the middle. I believe they have you do it 2-3 times to make sure the results are consistent.
The FeNO test is yet another way your doctor can measure how your lungs are doing and how well your asthma is controlled. There's spirometry, FeNO measurement, and simply asking a bunch of questions to see if you're having any symptoms, and when.
I do have allergic asthma as well, and I'm well-controlled on Pulmicort. I have in the past been on Asmanex. Then I was on Symbicort for a few years, but that caused me acid reflux. So I've been on Pulmicort (also a dry powder inhaler) for almost a year, and I like it. I've never had problems with thrush, luckily.
Hmm, I'm wondering if you really need a spacer with the Alvesco. If I recall correctly, Alvesco does not transform into the steroid until it gets into your lungs, which would reduce the incidence of thrush. Maybe this is something to discuss with the doctor, or maybe the Alvesco website has some info on this.
Anyway, good luck with the Singulair, hopefully it gives your asthma treatment an added boost without side effects, as it does for me. JudyView Thread
You know, like most other issues with medication, it probably depends on the person. I've taken Singulair every day for 6 1/2 years without any side effects. For me, Singulair has a pretty mild effect by itself, but in combination with an antihistamine it works better. (There's quite a few studies out there confirming that Singulair plus antihistamine is more effective than either med alone.)
Why not get a week's worth of samples from your doctor and give it a try? Then you won't be out the $$ for the medication in case it doesn't work for you, or if you get any troublesome side effects.
Just a thought - hope it helps. Take care & good luck. JudyView Thread
First, it's a good idea to tell your doctor about this occuring to you, and to ask what time of day you should take your Alvesco. Follow what your doctor says, not what random people tell you to do. (FYI when I took Asmanex some years ago, I took it in the morning per my allergist's recommendation, so there is no rule you're "supposed" to use Asmanex at night.)
Second, it's possible that your lungs are more "twitchy" at night. It may be because after a day of exposure to your allergens they are more sensitive. It may be that you have undiagnosed acid reflux that is inflaming your lungs and that crops up after dinner. It may just be your body's circadian rhythms (cortisol is lower at night). So, if your lungs are more twitchy and sensitive at night, that would explain why taking Alvesco at night would bring on a coughing fit while that doesn't happen in the morning.
Maybe your doctor will let you skip the nighttime dose. Or maybe he/she will tell you to use your albuterol inhaler first, to ward off the coughing.
Again, your best bet is to revisit your doctor and let him/her know how you're doing on the Alvesco and to answer all your questions.
Hope this helps. Take care & good luck. JudyView Thread