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Pulmicort (Budesonide)

###table###Pulmicort(Budesonide)
Other names: Entocort, Pulmicort Inhaler, Rhinocort
ASTHMA IN CHILDREN: MANAGING SEVERE ATTACKS
I would like to mention how the child should be managed when the attack subsides. If the attack has been mild then normal activities can be resumed straight away. In more severe episodes it is important to take things easy for a couple of days. This not only allows the body to recover its strength but also lessens the risk of another attack developing. Research shows that it does take this amount of time for the blood gases and metabolism to return to normal. The most troublesome symptom in the aftermath is a cough, as there is always an accumulation of thick, sticky sputum. During an actual attack coughing is often suppressed as it may increase breathlessness to an intolerable degree. Unfortunately, as the attack lessens, coughing still seems to exert a narrowing effect on the airways which makes it impossible for the sputum to be brought up.
In the older child a simple method of helping is to breathe out against slight resistance; that is, by pursing one’s lips as if to whistle and then breathing out in a slow and determined fashion. This technique helps to bring up sputum to the point at which it can be gently coughed up without difficulty. Another way of clearing the mucus is to gently blow one’s nose.
I always advise children to avoid violent coughing at this stage as it will increase exhaustion and can actually cause minor damage to lungs that are already very sensitive. In general I have found many of the medicines available which claim to enhance the coughing up of sputum to be of very little value.
I have explained the treatment of a severe asthma attack using only the medications that are absolutely necessary. These do not actually involve many different drugs, really only a bronchodilator to relieve muscle spasm and a cortisone preparation to settle any swelling of the airway lining. It is the amount and method of administering them that is so important.
I would like to describe the situation of a 6 year-old girl called Kate who was an asthma sufferer. She had just joined my list as her family had recently moved from another part of the country. I asked whether she was on any treatment and this is the list her mother gave me. She was on Ventolin syrup for the muscle spasm, a cough medicine, a sedative medicine to calm her down, an antibiotic to prevent infection, a long-acting bronchodilator tablet, a laxative to counteract the constipation that this tablet was causing, vitamin tablets, a Ventolin inhaler, a Becotide inhaler, an Intal spinhaler and a Bricanyl inhaler in case the Ventolin made her shake. This made eleven preparations in all. I am surprised that Kate could remember which she was supposed to take at what time and I am certain that with this many drugs there was some interaction between them.
I stopped all the medicine by mouth and also her Intal and Bricanyl inhalers immediately and without hesitation. This left her with a Ventolin and Becotide inhaler out of the original eleven. I added a volumatic to make the two inhalers more effective if she became slightly wheezy and her parents agreed to buy Kate a nebulizer. I also prescribed her a course of cortisone tablets to keep at home so they could be used in an emergency. Thus, instead of the original array of medicines and tablets, Kate was managing solely with Ventolin and Becotide which could be given in three different ways depending on the severity of the attack. Hopefully the cortisone tablets would never be needed. Kate had never even heard of a peak flow meter let alone been shown how to use one, so her parents had no way of managing their daughter’s condition. Three visits to the asthma clinic at my surgery soon changed that and when I saw Kate a month later I could immediately sense a much greater self-confidence in her. I am sure that there are many other children on the same ‘notch potch’ of treatment that Kate was on originally which is far too complicated and totally unnecessary. If your child has asthma it is wise to be under the care of a doctor experienced in the management of this condition. By following this complete treatment plan it is most unlikely you will ever need to summon medical help, but it is always comforting to know it is there if really needed.
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