Dear Dr Nina: Will I put two-year-old daughter on inhaler?
My two-year-old daughter has been prone to chest infections since she was born and after her last bout of antibiotics, the GP said it might be time to consider putting her on an inhaler.
I've got the prescription now but friends have told me that putting her on an inhaler at such a young age will only make her problems worse. The GP said it was up to me to decide if I wanted to go ahead with the inhaler. She seems okay at the moment but it's probably only a matter of time before shegets another chest infection. What are the drawbacks to inhalers for small children? I have no experience of this as there is no asthma or anything like that in my family.
Dr Nina replies: Think of our airways as a tree. The trunk is called the trachea. The larger branches are called bronchi and the next small branches are the bronchioles. If there is inflammation anywhere along this tree irritation can occur. Irritation in the airway may be noticed as a cough, wheeze or shortness of breath.
Asthma is a condition in which there is sensitivity, irritation and inflammation of the airways. Chronic cough in children can be a sign of underlying asthma. Asthma isn't usually diagnosed under the age of two but in those over this age with chronic cough, it may be reasonable to start a trial of inhalers to see if symptoms improve. There are number of factors that put people at risk of cough and wheeze. Household smoke exposure is a well-known risk, especially maternal smoking, so it's important not to smoke at home and not allow anyone else to either. Asthma can run in families but this isn't always the case. A family history of eczema and hay fever also increases the risk.
The symptoms of asthma can be frightening for parents as the wheezing and coughing can be quite pronounced. Your daughter's symptoms are not unusual for those with asthma. For some people with asthma the winter is particularly problematic. The cold weather or simply being indoors and exposed more to house dust mites can trigger a flare causing cough, wheeze and shortness of breath. Respiratory infections are also a trigger. You did the right thing chatting to your GP and it sounds like he/she feels it's worth trying an inhaler.
It is important to point out that uncontrolled asthma is a serious condition that can cause harm. I have no concerns as regards the use of prescribed inhalers in children who need them. They can be lifesaving.
Asthma is not a curable condition, although some do outgrow it, and so we talk about gaining control of symptoms. Asthma is considered controlled if a person feels well, has no cough, wheeze or shortness of breath day or night, can carry out normal activities and needs to use the blue reliever inhaler less than twice a week. If symptoms don't settle with a blue reliever inhaler alone it may be necessary to add in a preventive inhaler. These are usually inhaled corticosteroids and are often referred to as the brown inhaler. This inhaler must be taken regularly, usually twice daily, to help control symptoms. If corticosteroids alone are not enough then a combined inhaler, which has a long-acting version of the blue inhaler and corticosteroids, may be recommended. For more severe asthma other medication may be added. If symptoms regress then treatment can be stepped back down again.
In the event of a cold or viral illness it may be necessary to temporarily increase asthma treatment. Having an action plan in place can be very helpful at this time. This can be agreed between you and your doctor. It is always worth having an occasional check up with your doctor to assess asthma control. Getting an annual flu vaccine is also essential. Asthma symptoms can vary seasonally and so may need treatment but it is always important to stay vigilant and aim for good asthma control.
Q. I’ve been on antidepressants for two years and I feel much better than I did back then. My GP says it is time to come off them, but I’m nervous about the side effects and a potential relapse.
Dr Nina replies: Depression can occur after a major life event such as bereavement or can occur with no obvious cause. Many people are also afraid of what the treatment for depression might involve and so don’t approach a health professional about their feelings.
However, treatment for depression has improved greatly recently and it can be tailored to each individual’s personality and needs. Medication can be an important part of treatment. I advise patients to think of medication as a crutch. It can provide strength and support while all the other treatment acts to make you strong again. In those who are depressed for the first time, the minimum recommended course of treatment is six months.
Your GP may suggest weaning medicine if you have been well for a period of time. With a slow wean you should not experience any withdrawal symptoms. If your mood starts to dip then the medication dose can be increased again. Relapse occurs in some people. If that is the case then medication may be required for a longer period next time. Some people remain on medication long-term. Stay in touch with your doctor. Once the focus is on your mental wellbeing it is likely that the right decision will be made as regards medication dose and duration.
In depression, lifestyle change and psychological therapies are also important. Taking a daily walk can help improve mood. Eating a healthy, varied diet also helps. Caffeine and alcohol should be kept to a minimum. Counselling and psychotherapy are invaluable. Cognitive behavioural therapy targets the issues causing low mood and is especially helpful. In more severe or recurrent cases of depression, longer-term medication may be required but should not be feared.
Health & Living