Brief Answer:
Please give more details

Detailed Answer:
Hello XXXXXX,

Thank you for asking at HCM.

I went through your history and would like to know more about your son as follows:

1. Does he have continuous cough for last 8 months or he improves in between?

2. Does he have more cough during day or during night?

3. Is there any particular season when he is good or bad?

4. Has he ever had difficulty in breathing? Has he been nebulized any time? What is the frequency of his asthma symptoms?

5. Does he have nose symptoms like running nose, sneezing, blocked nose, etc?

6. Does he have eye symptoms like itching, redness, lacrimation etc?

7. Does he have vomiting of foods, especially after heavy meals?

8. Does he have any complaints related to stomach like diarrhea, constipation, abdominal pain etc?

9. Has he ever had any skin allergies?

10. Does he have symptoms with fever or without fever?

11. Does he have any one in family with allergies/asthma?

12. Does any one from home smokes? Is he exposed to any other smoke/dusts/pollution in home?

Above details would help me to know your son's problems better. Please give above details on follow-up.

At present, I would like to make suggestions for your son as follows:

1. After knowing above details, I would suggest your son allergy testing. This will help you to know the substances causing allergies to him as well as to know the measures to avoid them.

2. Seroflo inhaler is usually considered appropriate treatment for childhood asthma, however, I would like to know above details before giving my opinion about his need of inhaler.

I would like to mention here that Seroflo is a "preventer" type of inhaler, it should be given on continuous basis and not on as-and-when-needed basis. Please give it only according to doctor's advice.

3. I would also like to emphasize that technique of using inhaler is very very important in children. I would suggest you to use inhaler with spacer with mask. Please make sure the technique of using inhaler is perfect by demonstrating your method in front of your doctor. This is very important as if technique is not perfect, drug may not enter lungs in adequate amounts and treatment may seem ineffective.

4. 80-90% of the children "come out" of asthma by age of 6-7 years. So yes, I would agree with your doctor.

5. Seroflo inhaler contains two drugs - inhaled corticoteroid (fluticasone) and salmeterol.

Common side effects are oral thrush, throat irritation, change in voice, etc due to fluticasone and tremors, increased heart rate, etc due to salmeterol.

However, by ensuring proper technique one can minimize the side effects.

Serious side effects can occur if high doses of inhaler are taken for long periods.

6. In general, I would suggest your son avoidance of dusts, smokes and air pollution as much as possible.

7. I would also suggest him a healthy diet rich in vitamins and minerals (plenty of green vegetables, fruits, sprouts, etc) to maintain good immunity.

Hope above suggestions will be helpful to you.

Please provide more details so that I could be more specific in my opinion.

Wish your son a very healthy life ahead.

Thank you & Regards,

Dr Parin N Parmar

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Brief Answer:
Allergy testing, montelukast and ranitidine

Detailed Answer:
Hello Mr XXXXXXX,

Thank you for your follow-up.

From your details, I would like to make suggestions as follows:

1. I would suggest your son allergy testing for common food allergens (peanut, milk, wheat, soy, tree nuts, egg, fish, shell fish - I would suggest to include only foods that he is taking regularly/frequently) and common air-borne allergens (house dust mites, insect proteins, indoor molds, regional pollens and pet danders if you have pet).

This will help you to identify the substances he is allergic to and also to know the measures to avoid them.

2. Were I treating him, I would also prescribe him daily montelukast and ranitidine for at least 6-8 weeks. It would help to reduce dose of inhaled corticosteroids earlier and improve control of asthma.

3. I would also prescribe him a multivitamin-multimineral supplement for at least 3 months along with vitamin C which will help improve his immunity.

4. Regarding need of the inhaler (Seroflo), I would suggest it to continue at least for 6 weeks. Once his asthma improves after starting montelukast, ranitidine and allergen avoidance, please reduce the dose of inhaler under your doctor's guidance.

5. Rest of my suggestions would be same as mentioned in the previous answer.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask at follow-up.

Wish your son the best of the health ahead.

Thank you & Regards,

Dr Parin

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