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Son newly diagnosed – questions about BREO

Sorry this is so long, but I wanted to be comprehensive.

For maybe a year or so, our son (now age 12 1/2) has experienced periods of a chronic, nagging cough that would continue for maybe 2 weeks or so.  Not huge coughing fits, just periodic, throughout each day, annoying, irritating, nagging coughs.  Those periods of time usually followed a cold, but sometimes they'd appear out of nowhere.  I just assumed they were seasonal allergies and gave Allegra or something like that.  But eventually, my brain started humming.  Both my mother and father have been taking Advair for several years due to what they call asthma-like flare-ups or bronchial issues.  Not severe asthma attacks.  Just nagging coughs, like our son.  This past Saturday, our son stared coughing again, just like that, right in the middle of the day.  

We got a recommendation from multiple parents in our town for a local physician who specializes in pediatric allergy and asthma.  The parents all swore he's the best of the best.  The appointment was today.  Our son was skin tested for allergies and showed a reaction to grass pollen (his previous long bout of coughing was maybe early June, so that's interesting).  Nothing else.  The doctor said his lung function was 70%.  Based on that and his history of coughing, he prescribed BREO.

Since coming home and doing research, I now have questions.  I'll call the doctor to ask, but I thought I'd get thoughts from you experts here in the meantime.

1.  The doctor didn't seem to think 70% was terrible.  From my research it looks like it's not severe/dangerous, but it's not exactly borderline either.  I should say that on Monday evening he came down with a cold, and it was really cruddy yesterday.  I called the doc's office and they said it didn't really matter and he could still come in today.  He's much, much better today (minus the cough, which started a couple of days before the cold), but I again during the appointment asked if this posed a problem for the lung test.  The doctor said it wouldn't affect it in a meaningful way.  Hmm.

2.  Why would the doctor start with a combo inhaled corticosteroid/long acting beta agonist vs just starting with a steroid?  Is it because his lung capacity was so low?  Or because he's already in the middle of another round of coughing?

3.  I think (could be wrong), BREO comes with a 100mcg dose and a 200mcg dose.  He's starting our son on the 200mcg one.  Again, isn't this a bit much for starters?

4.  The doctor didn't definitively say he has asthma per se.  I wonder why?  He used some other term but can't remember.  We're sort of in the middle of some testing and medication decisions with our older son (epilepsy) so my brain is just fried this week.

5.  During the allergy test, our son also developed a small welt and itching on the clams area.  Odd.  He's eaten clams, eaten them often, and eaten them fairly recently, maybe a couple of months ago.  He did not show a reaction to any other shellfish.  The doctor didn't seem at all concerned, said he doesn't believe our son is actually allergic to clams, and said that it's good to be aware when he eats them but that he truly believes it's safe.  So.. yeah, I'm confused.

If you made it through ask that.. well then, thanks!!!  Any thoughts are GREATLY appreciated.

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  • Melissa G

    My first question is, is the doctor a board certified allergist/pulmonologist? If no, I would seek a second opinion with one. 

    I would definitely contact the dr and express my concerns. 

  • Ameli79

    Yes, he is.  I actually spoke with him again a short while ago.  

    He describe what my son has as cough variant asthma."  Frankly, that's what I suspected he has.As for the combo vs just a corticosteroid, he said that, quite simply, he thinks my son would benefit from both and that the vast majority of his patients on it have had a great response with no problems.  So, as far as he's concerned, he wants to give him what he thinks is best for him, and he thinks it's the combination.  As for thrush/candida, he said that of every 100 patients in their practice, typically maybe 2 have issues with that. He said it does happen, and for whatever reasons some people simply are more prone to it. I guess it's like other candida infections in that regard. So we'll just make sure my son rinses and gargles/spits. And I'm also to emphasize to Will again that when inhaling, he really needs to pull/inhale from his lungs, and not his mouth.  I also asked about the 200 mcg (of the steroid portion) dose vs the 100 dose. He said he prefers to start with higher doses of corticosteroids to get things under control and truly ensure that everything working, and then he often moves them to a lower dose after that. He's just personally found that to be the best course for his patients.  

  • Melissa G

    Do you feel better about things now that you talked with the dr? 

    I agree, some people are just more prone to thrush…with five of us on inhalers in my home, not one of us has gotten thrush from the inhalers. 

  • K8sMom2002

    Hi, and welcome Ameli79! I have definitely heard that many allergists and pulmonologists like to start with a higher dose to get things under control and then step down. 

    Here's more about .

    Is this doctor a pediatric allergist or pulmonologist? 

    I ask because your son is 12, right? Many kids who have asthma and who are four or older use other medications … medications like QVAR, which is a similar type of medication to BREO. I'm just curious as to why your doctor decided to use BREO instead. 

    You can check out  to find links to the various prescribing information for each asthma medication.

  • Ameli79

    He is a pediatric allergist (specializing in allergy and asthma).  I'm not sure if that's a problem, and if he should be seeing a pulmonologist?  A lot of people here swear by him.  But I want to make sure it's the right move.

  • Brenda Silvia-Torma

    Hi Ameli79, Welcome to AAFA!  I've been on Qvar since June and I had one bout of thrush in back of my throat (I'm also on a low dose of doxycycline for ocular rosacea). The medication mouthwash did the trick…I had been rinsing my mouth, but didn't realize I needed to gargle Sigh. Since I've been doing that ritual routinely, I haven't had a problem again (knock on wood!)

    So glad you got all of your questions answered!!

    Brenda

  • Ameli79

    Brenda, I've told will to rinse first, then gargle and rinse, and he does that right before he brushes his teeth before bed.  Hopefully that will do the trick!  It does make sense to gargle, because that of course would get the back of your throat.  I learned the on this site.  Thanks to everyone!!

  • Brenda Silvia-Torma

    That is a good plan…that is what I do now too.   I agree, this site has been such a huge help to me as I've navigated my asthma diagnosis…

  • Ameli79

    Thank you for checking in.  He's doing better now.  The cough is almost gone.  Quicker than it usually goes away after a bad cold.  The doctor also prescribed a rescue inhaler in case he has another bout of nasty chronic coughing that he can't shake.  I'm supposed to check in with the doctor in a couple of weeks.

  • K8sMom2002

    So glad things are turning around!

    And yes, with my asthma, I learned that the "coughing spells" that I'd had all my life were actually asthma attacks. Using the rescue inhaler according to the  my doctor has give me really has helped things not progress. 

  • Ameli79

    I’m really hoping this helps him. It’s so uncomfortable and frustrating when he gets those coughs for so long. 

  • Melissa G

    It is so hard to watch our children struggle! I hope he doesn't have another bout of the terrible coughing!

  • K8sMom2002

    Ameili179, how are things going with your son? Have your kiddos started back to school after the Thanksgiving break?

    For us, with asthma and allergies, it wasn't just getting the medication figured out and the action plans in place, but we needed to figure out who were our allies … what grownups and who of our kiddo's circle of friends could support her. 

    How's your son doing with adjusting to the diagnosis and the meds?

    When I read a recent blog post about friends and how important they are, I thought of how DD's friends really helped us through some of the rockiest of our transitions. It's about kids who manage food allergies, but I think it's good advice that could apply to any chronic disorder, including asthma. 

    Here's the link … . It's on Kids With Food Allergies, which is a community that is also run by AAFA. The blog had lots of good tips and advice, and it really resonated with me!

  • Ameli79

    Thank you for checking in.  He's doing well.  Getting used to taking his nightly medication, and he's honestly not that bugged about the diagnosis.  I think he was relieved, because now he feels like there's something he can actually do to help with that cough.  Before, he was so frustrated.  Now we have the BREO, and he does have a rescue inhaler should he still run into any days of chronic coughing.  He's not too concerned, only because the doctor said that his asthma is the "cough variant" type and not something we should worry about at this point (although we should watch for any progression or severe symptoms).  As for the allergies, he hasn't tried clams since the test.  But a second doctor at the practice also said that it was likely a false positive.  I'm still not clear why, although I can tell you he has eaten clams many times over the years, as recently as a few weeks ago.  Confusing!

  • K8sMom2002

    Oh, that's great that he's feeling better and more in control of his asthma! 

    As for false positives on food allergies, yep, that happens. Here's more about . 

    An interesting quote from that resource says this:

    However, a good rule of thumb to remember is, if your child can eat a food without developing any symptoms, then they are unlikely to be allergic to that food. Why is that? Because the best test is actual ingestion of the food.

    It sounds like your son has been able to eat clams without any problems. My daughter tested wildly positive to soy, but she has no issues eating or drinking soy, either. Many docs now don't test unless they suspect a food allergy to a particular food.

  • Ameli79

    That is immensely helpful!  I was trying to get an understanding of why the doctors were so unconcerned.  They did ask if he'd eaten clams in the past, and once I told them that he had quite often, they were pretty certain that he could continue to do so. I might watch anxiously for a couple of times anyway, lol.  But it is good to know that their lack of concern is based in sound reason!  I'm still learning the terms referenced in that article, but it does make sense.  

  • K8sMom2002

    Yay! So glad that it helped! And so glad he can continue to enjoy clams … but now I want a nice big plate of fried clam strips!

  • Ameli79

    You're so kind.  He is doing great so far.  We had a follow-up appointment, and his lung function was much, much better.  The doctor suggested that we can lower his dose to the 100mg BREO (down from the 200mg).  The real test will be when he gets his next cold, and during allergy season.  But it was great finding out how much his lung function improved!  He hasn't yet eaten clams, but at the last appointment the doctor again emphasized not to worry about that.  Even so, when we go on our next vacation out of the country, I might steer him away from clams just in case, lol!

  • Brenda Silvia-Torma
    K8sMom2002 posted:

    An interesting quote from that resource says this:

    However, a good rule of thumb to remember is, if your child can eat a food without developing any symptoms, then they are unlikely to be allergic to that food. Why is that? Because the best test is actual ingestion of the food.

    It sounds like your son has been able to eat clams without any problems. My daughter tested wildly positive to soy, but she has no issues eating or drinking soy, either. Many docs now don't test unless they suspect a food allergy to a particular food.

    Agreed! I am supposedly allergic to fig…but I've always been able to eat fig newtons with out any problems! 

  • Ameli79

    I wouldn’t even have thought they’d automatically test for figs!  It’s not the most common food. Although I love them. Glad you can enjoy your fig newtons. I haven’t had  one in years.  Now I want to go out and buy them!  

  • Ameli79

    He's doing fine.  He did have a recent cold, and unfortunately it seemed like he still took a long time to get over the cough.  

  • Melissa G

    Ameli79, very happy to hear that your son is doing fine! Yikes that he got a cold! There have been so many viruses going around.