combivent for a 12 year old

[pedspnp]

I had a pedi pt seen in the acute care clinic for her asthma excaberation. she was given a neb tx and started on combivent in addition to her advair singulair and prn proventil but not started on a prednisone burst. I dont understand the reasoning for not starting her on prednisone . When i saw her for f/u she was still having exp wheezing and cough. peak flows in the yellow range I started her on prednisone and will follow up with a phone call and office visit, I am wondering if i am missing something here, usually combivent is used for copd or emphysema but a 12 year old who is usualy well controlled on her maintence meds getting combivent in addition to her proventil for a excaberation. I dont understand the rational here so please help

[wowza]

The physiology of adding ipratropium is the same in COPD and astham; it adds extra bronchodilation. I agree though that a steroid burst should have been added for a flare.

[ominous]

Usually wouldnt use both in peds pt. The advair is plenty for her. And yes, she should have received a 5 day steroid burst. I have never used combivent in peds.

[pedspnp]

i have never ordered combivent for peds either.

[Blessedx3]

THe Combivent prevents bronchoconstriction-but is not a relief med..I agree--the prednisone burst is warranted.

[razorman]

I just put an 11 year old on Combivent. I chose it to help dry up some of his secretions.

This boy has been a challenge for me constantly. He's missed a ton of school due to his asthma exacerbations. Mom is less than an ideal caregiver what with her smoking and all. She has him on albuterol nebulizers every 4 hours and thinks that's an acceptable answer. She is absolutely anti-steroids (though she can't explain why).

[pedspnp]

Sometimes parents hear the word steroid and associate it with body building etc, once they understand that the steroid we are talking about is not the same thing they are ok with it. I have had parents reluctant to start steroids but when i explain to then the benefits vs risk they are ok with it. What other meds is he on other than albuterol nebs, will they even consider an inhaled steroid,

[razorman]

He's only on albuterol nebs and has a Xopenex HFA. I'm really contemplating a Munchausens(sp?) by proxy issue w/ mom the more I think about it. She is just SO reluctant to do anything.

[pedspnp]

He's only on albuterol nebs and has a Xopenex HFA. I'm really contemplating a Munchausens(sp?) by proxy issue w/ mom the more I think about it. She is just SO reluctant to do anything.[/q

Maybe explaining to the mom the risk/benefit, to the mother, sometimes you just have to be blunt and tell them look if you don't want them on a inhaled or oral steroid because of the potential side effects how would you feel if your child had to be placed on a vent to help them breathe. You may want to talk to her about the potential side effects of overuse of albuterol nebs. I would probably refer them to a peds pulmonologist for a base line PFT and let them see if they have any success. I am sure you are documenting very well the mothers reluctance to try anything else in case something should happen down the road and they decide to start pointing fingers