Why does asthma flare up after Albuterol in a 4-year-old?

Question

Hello doctor,

My 4-year-old daughter has asthma. She was diagnosed with a moderate asthma flare at urgent care four days ago. Flovent was increased to 88 mcg twice daily, Albuterol 2.5 mg every four hours for 48 hours and Prednisolone 15 mg/one teaspoon one and a half tablespoon once daily for five days. She seems to be having retractions at night between 10:00 PM and 2:00 AM like clockwork. They are not severe as her respiration rate is 22-28, and pulse oximeter reading is 96-98 %. Pulse is elevated at times due to Albuterol, and the highest recorded is 160 with no fever. She is tired and is pale in the face with dark circles under her eyes.

I followed up with the paediatrician yesterday, and he diagnosed her with an ear infection and put her on Augmentin. He listened to her lungs and said they sounded fine. She had an Albuterol breathing treatment about one hour prior to her visit. These symptoms that come on at night are scary. Productive cough and the sound of occasional constriction in the throat, causing a gag, with these mild subcostal retractions.

It is hard for me to determine whether we should go to the ER or not. It is hard to justify a trip to the ER with normal vitals and these sets of symptoms. Wanting suggestions regarding whether my daughter is on the right treatment? Could this be something other than an ear infection and a viral illness, causing an asthma flare? She has been sick with a stuffy nose, postnasal drip, and mild cough for three weeks. She is also taking Claritin, Singulair, OTC Tylenol or Ibuprofen for ear pain and Mucinex. I also have a video clip of these retractions, and I am attaching it.

Kindly guide.

Answer 1

Hello,

Welcome to icliniq.com.

As per your history, it is very clear that your daughter has an asthma exacerbation. It can be because of an ear infection or a viral infection in the airways. As you said, in spite of antibiotics, oral steroids, and frequent nebulization, it is not under control. She needs urgent hospitalization to give her urgent care and to find out other problems if any. This flare-up is a valid justification for her hospital admission.

As she is a very young child, she needs treatment under observation. The very fact that oral treatment is not effective. She needs intravenous drugs and steroid nebulization, X-ray and other blood tests. So I advise you to go to the hospital for admission without wasting much time.

This will help to recover her fast and find out the exact cause of her flare-up. Once she is settled and the acute problem is under control. She can continue with her inhaler medicines as advised. I think this explanation is enough for you to explain her situation to you.

I hope this helps.

Please feel free to reach out incase of fuether queries.

Thank you.