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Dr. Jacob Puliyel, Consultant Paediatrician, St. Stephen’s Hospital, New Delhi, replies to this week’s questions.

My nine-month old daughter has had a persistent wheezing problem since August and was treated intermittently with Asthalin and nebulisation. Her paediatrician now suggests that we begin inhalation treatment with Seroflo 125. Is it advisable to begin as early as possible? Also, when and where can we have her tested to confirm whether or not she has asthma? If it isn’t asthma what else could it be? Name withheld

Answer: A wheeze is a prolonged respiratory sound usually heard while breathing out through a narrow airway. Older children wheeze because of constriction of the muscles around the airway in response to exposure to allergens. However c hildren under two years of age wheeze because the airways are narrowed by mucus secretions. The stimulus here is usually a viral infection and the resulting symptom complex is called bronchiolitis.

Some children with symptoms of bronciolitis go on to develop asthma but this is not always the case. Your child therefore does not have asthma and it is unreasonable to use this label in a nine-month-old girl. Bronciolitis sometimes responds to bronco-dilator therapy and inhaled steroids. However Seroflo is not even recommended by the manufacturers, below the age of four years.

My son is three years and eleven months old and has been prescribed seroflo inhaler for his consistent cough during odd hours in the night and sometimes in the day. The inhaler was suggested because I was an asthmatic. How safe is the drug? Can we find out whether the cause is asthma or not? Ram Prasad

Answer: Your son has a family history of asthma and his nocturnal cough may be a manifestation of reactive airway disease, another name for asthma. As your doctor has explained, it is worth giving a trial of inhaled steroids to check i f his cough responds. Very low doses of steroids are used in these inhaled preparations and therefore the side effects are minimised. Untreated, wheezing can do long-term damage, cause chest deformities and affect growth.

Seroflo is a combination drug consisting of a long acting bronco-dilator with an inhaled steroid. Standard therapeutic regimens advise inhaled steroids alone as first line treatment in children with problems like your son and this is safer.

There are tests that can be done to confirm if your child has reactive airway disease but most often, the diagnosis is made clinically. A good response to therapy can help confirm the diagnosis.

My son has been suffering from allergic cough throughout the year (specially in winter). Though not so frequent initially, it is now very frequent. Initially we gave bricanyl cough syrup with zyrtec but this winter the doctor put him on inhalers (asthalin and forcort 100). He has been on this for three months but has got only temporary relief.

Now doctors have put him on seroflo-100 twice daily, montair 4mg once daily at bedtime, crixan syrup (for five days), syrup zaid (for 15 days). Are these medicines safe since the child is only four? Will they have any side effects, especially seroflo, which our doctor has prescribed for a year? Will this allergic cough turn into asthma in future? Ramesh

Answer: Your son’s cough was initially treated with anti-histamine syrups assuming it was an allergic cough. Your doctor has now put him on inhaled steroids with a bronco-dilator (a drug that reduces constriction of the muscles o f the airway). He is now being treated as for childhood asthma.

A large number of such children outgrow their asthma and it is likely that your son may not have asthma as an adult but there is no way to guarantee this. The fact that the child was on these medicines early does not increase the chance that he will be asthmatic later. In fact the inhaled steroids, in adequate doses to keep him symptom-free, will help him grow and develop normally and allow him to participate in play, games and activities required of him at this stage and necessary for building his self esteem.

Chronic untreated asthma can affect his normal growth and development. Remember that not all nocturnal cough is asthma. If there is poor response to therapy, one may need to reconsider the diagnosis.

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