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Adoxa (Doxycycline)

Other names: Doryx, Monodox, Periostat, Vibramycin, Vibra-tab
Simon’s attacks were much more frequent and although he responded well to Intal his father thought he still had a tendency to wheeze at times, especially at night. It seemed that Simon, as well as having marked spasm of his breathing tubes, also had a degree of swelling of their linings.
For this I recommended adding the other type of preventive inhaler which contains a steroid. His parents immediately expressed dismay at the thought of this as they had heard of some of the less desirable effects steroids can have on the body. While it is true that when taken by mouth for long periods of time they can affect growth in children, this is not so in the inhaled form. As I have mentioned the real benefit of inhaling a medication straight into the lungs is that it is not absorbed into the rest of the body so side-effects do not occur. Steroids given in this way are therefore harmless.
This inhaler, the commonest of which is called Becotide 50, is different to the spinhaler in that it is a pressurized aerosol, and it is not necessary to insert a capsule as the powder is already contained in the barrel of the inhaler itself. By inserting one end into the mouth and as you breathe in pressing the bottom a set dose of medication is released and automatically inhaled. This is much easier than ‘messing about’ putting in a capsule but there are two potential disadvantages. First, it is necessary to ensure that the inhaler is activated just as you are breathing in or else the powder will not pass to the lungs. Second, even using the correct method the powder may come out with such force that some of it will hit the back of the throat and not go into the lungs. However, even with these drawbacks it is still a most effective treatment and in Simon’s case the simple addition of two puffs twice a day stopped the underlying wheeze.
So now we can start to build up our complete treatment plan. We know that to prevent an asthma attack we should first use Intal and add Becotide if it is ineffective. Sometimes if there is still insufficient control it may be necessary to increase the strength of the steroid to Becotide 100. Very occasionally children are unable to use the inhaler correctly and then it may be necessary to change to a diskhaler where the steroid is in powder form. This is sucked into the lungs as they breathe in but does not rely on coordinating breathing in with operating the device. The disadvantage is the same as for Intal, i.e. special discs containing the powder have to be loaded into the diskhaler.
Although delighted at their respective children’s improvements, both sets of parents were worried as to how they could tell in the very early stages if the preventive treatment is insufficient. Obviously it is easy to tell if the child starts to wheeze but it would be much better if an impending asthma attack could be diagnosed some time before the wheeze starts. In general the quicker the treatment is started the faster the attack will settle. The easiest way of telling is by the appearance of an irritating cough, which means the airways are becoming twitchy and may soon tighten up. In my own three children, especially Ross and Tina, the cough is very pronounced and gives us about two hours to reverse the situation before the shortness of breath begins.
However, this cough is not always present and a far more active way of showing that problems with breathing are starting is by the use of a peak flow meter. This is a small portable plastic device which in essence measures the amount of air which can be forcibly blown out of the lungs.
The peak flow meter is a vital piece of equipment and no child with asthma should be without one. They can now be obtained on prescription from your doctor. The end of the tube with the mouthpiece is placed between the lips and a deep breath in is taken. The child then breathes out as hard as possible and the force of this exhalation pushes a pointer up the scale. If the breathing tubes are tightening up, i.e. they are becoming narrower than normal, then the child will be unable to blow as much air into the peak flow meter and a lower reading on the scale will be produced. The measurement that can be achieved depends on age, height and sex, so it will vary for each child. The readings are usually constant at a certain figure, and if they then start to decrease it indicates that the airways are starting to narrow and an asthma attack is on the way. In general the breathing tubes are naturally a little narrower at night than during the day, so another pointer is if this gap in readings between the morning and evening starts to widen. (This also explains why asthma attacks tend to be worse at night.)

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