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discontinuing inhaled corticosteroid and spirometry test

My son is 5yrs old and is allergic to dogs and the presence of some dogs in the house has previously triggered an asthma reaction. We had a dog and had trouble in controlling his asthma when he was 3-4 years old. When we found out about his allergy we moved our dog to the grandparents home. At the same time the allergist switched him to a new inhaled corticosteroid and now is taking Alvesco (80 micrograms every other day). He has been doing very well with no need of any Albuterol in the last year and with no symptom of asthma. We would like to trying to discontinue the inhaled corticosteroid but we heard different opinions. The spirometry FEV1 value usually is in 79-80%. Recently an allergist took a measure and got a very low number (50%). However, I noticed how little effort my 5 year old put in blowing and I told the didn't do it right. At that point the doctor already recommended to double the dose. After insisting many times he took again the test and the number came as in the past (i. e. about 79). I have to admit that considering the huge variability of this test I am not sure how much I can trust a medication prescribed based on this test. This is obviously due to lock of effort that might happen at this age. He really has no symptom not even after 1h of gymnastic or running around playing soccer.

What other test might be performed that is more reliable for this age range and is there anybody in the washington DC area that could do it?

Obviously I do not want to try discontinuing the medication without medical advise but at the same time I also would like to see if it would be possible to slowly discontinue the medication.  This is also after reading that many kids that had asthma in this age range they actually grow out of it and the fact that my son has been symptom free for 1 year (first taking for 8 months 80 microgram everyday of Alvesco and then only taking it every other day for the last 4 months)

Any advise??

Thank you,

Sam

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Comments 11

  • Jen

    Hi @Sam Sam,

    Welcome to posting.   I think your question is a very good one.  Have you asked your son's allergist about your concerns?  Would you be open to seeking a second opinion?

  • Sam Sam

    Thank you for your comment. Yes, I am considering to get a second opinion or change allergist all together. I would be particularly interested in going to a center where they have alternative ways of measuring the lung function that might work better in 5yrs old kids. Do you have any suggestion?

  • Katie D

    Welcome Sam Have you checked out our which discusses the different tests that are available in diagnosing asthma?

    We also have some information our which discusses about a step-down method to reduction of medicines, under the section titled "Will I Always Have to Take the Same Amount of Medicine?"  That might be helpful reading to you.

    When searching for a new allergist we always recommend finding one that is Board Certified.  On the bottom of the we have a finder that you can use to locate one in your area.

  • Sam Sam

    Thank you Katie for your response. I looked at the pages you indicated but they are of general information and in my specific case do not contain an answer to my questions. For example, I asked the specific question about experience in discontinuing the medication in kids. The "asthma  treatment" page has nothing on this.However, it is not uncommon that kids with asthma grow out of it and their medication can be discontinued. The same for the "diagnosis page". Although spirometry is a good test for older kids it is not even recommended for use in kids younger than 5 e considering that not all kids are the same it might not be so useful even for kids that are 6 or 7. The reason being because it is so dependent on the level of effort that a kid would like to put in blowing.

    To comment on the "trigger" test this could be useful in some cases but if the only trigger is an allergen and you can avoid the allergen all together you would thing that there is no need to keep using a medication routinely.

    Yes the allergist I consulted is board certified but I was hoping to hear from some personal experience.

  • Kathy P

    Hi Sam – that's awesome that your son's asthma is so well controlled. I totally understand wanting to see if the ICS is still needed. Does you son have "seasons" when he seems to have more issues?

    Both of my kids are in college, but both has asthma issues from the time they were toddlers. I can't recall if either did spirometry testing when they were young. They have been on and off various controller meds over the years. Currently, neither are on a year round controller. They both have rescue inhalers and a controller on hand for when they get sick. 

    So all that to say, discuss with the doc about trialling reducing or discontinuing the ICS. My kids often were only on controller meds seasonally – their allergies we're bad in fall and then we went into cold and flu season which was also a bad time for them. One thing to remember is that the goal of being on a controller is control. A lot of times people then think they don't need it anymore because their asthma is under control. So they stop taking it and symptoms come back. But it's reasonable to work with your doc to make sure he's on the least amount of meds to keep things under control. 

    There is a test called FeNO testing that can look for inflammation in the lungs. We have a blog on it and I'll grab you that link. I don't know if it's used in children though. 

  • Sam Sam

    Hi Kathy, The FeNO test seems a good alternative to the spitrometry and hopefully less sensitive to the level of effort a kid puts into blowing. I am guessing that my allergist does not have it or they might have done it. I'll ask and perhaps investigate if any in the area can perform it. The link above didn't work for me but I searched FeNO on the main page and got the following link that briefly describes the test.

    Thanks again!

  • Kathy P

    That's weird that the link didn't work. Not sure what happened there! I'll go fix it. 

  • K8sMom2002

    @Sam Sam, good job on monitoring your kiddo's technique during the test and mentioning its possible impact on the results! 

    Doctors are hesitant to rock the boat when things are working, but I think it's worth at least talking to your doctor and/or getting a second opinion to see if you could try a reduction in the meds. 

    Like Kathy, my DD had more severe asthma when she was much younger. It's not that she's "grown out" of her asthma, but more like she's grown into more of a tolerance to triggers. Another thing: her big triggers are upper respiratory infections, and as she has grown older, she doesn't seem to catch a cold. every. single. time. someone sneezes. 

    Could you talk to your doctor about a short trial without the meds? With a backup plan in case things aren't as well controlled as you are hoping? That's what we did when we discontinued DD's Singulair due to some possible side effects. 

    You could ask:

    • when's the best time to try this? (If he had worse "seasons" of asthma or most of his severe exacerbations in a particular season, then you could avoid trying it then.)
    • how should we discontinue the meds? Should we taper it or can we try stopping it abruptly?
    • what should we consider a success?
    • what should we look for as a red flag to start back?

    Has your kiddo had ? That can definitely reduce the risk of asthma-related complications.

  • Anne P

    Have you tried the pulmonary medicine clinic at ?  They have an asthma clinic, and they're the most likely to have the FeNO test since it's more cutting edge.

    My kids have seen pulmonologists there for many years, and my daughter could not do a PFT until she was around 7 because she was tiny for her age and didn't have the necessary lung power.  However, she was very symptomatic and flared easily (unlike your son).

    BTW, the FeNO is still considered experimental; and some insurance companies will not cover it. You might want to check with your insurance company and with the doctor's office to see how much it will be out of pocket.  

    I had to pay in full a few months ago because my insurance company deems it experimental.