Grab her inhaler! That LOOKS like an asthma attack! Oh, oops . . . anaphylaxis:

[SilverLining]

The first five posts within this thread were copied from our old forum.  http://allergy.hyperboards.com/action/view_topic/topic_id/17634

Posted: Dec 29th, 2010 at 05:42 pm   
In another topic I started, a discussion arose about managing a child with both asthma and anaphylaxis. I agree with the suggestion that the topic be given its own thread because of its importance, so I'm copying my comments in this new thread:

GLADLY will I explain the use of epi pens for asthma.

To hopefully give credence to my explanation, I will mention that my DD saw the Division Head of Allergy, Asthma, and Immunology at Children's Memorial Hospital in Chicago. I told her allergist that I was concerned that I had read of multiple instances where a child seemed to be having an asthma attack, was given an inhaler, but died because the child was really having an anaphylactic reaction and by time that was recognized the epi pen was either given too late or the child was dead. I asked her how I could distinguish between an asthma attack and anaphylaxis.

She explained that it is virtually impossible to distinguish between an asthma attack and anaphylaxis. She said if my DD had ingested any food within the last two hours, to regard an asthma attack as an anaphylactic reaction and give her an epi pen. She said that epinephrine used to be a common treatment for asthma attacks, so if she was having an asthma attack the epi pen would help her. And if she was actually having an anaphylactic reaction, the epi pen, of course, likely would save her life. (I generally don't put a lot of weight on the "two hour" qualifier because my DD has had numerous reactions to minute quantities of her allergens. I theorize that especially when she is at school or other high-risk areas, she could just as easily be having a reaction because she touched a doorknob with remnants of her allergens and then touched her mouth.)

She also explained that children with asthma, even if mild and/or well-controlled, have a higher-risk of dying from an anaphylactic reaction. (The other factor that predicts a fatal reaction is a prior anaphylaxis. My DD has both.)

I had her write that asthma should be treated as anaphylaxis into the action plans. I wish this was highlighted more. I think it would save many lives because when a child has an asthma attack, I think the natural response is to grab an inhaler. But with asthma attacks and anaphylaxis being indistinguishable, that understandable confusion could unnecessarily cost lives, especially when an epi pen would alleviate both anaphylaxis and asthma.

I don't even leave my Dd's albuterol for people who watch my child.

I tell them that if my DD is having an asthma attack they simply need to give her an epi pen and call 911.

HTH

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Posted: Dec 29th, 2010 at 06:08 pm   
Thank you so much for posting that. That could save someones life.

I never knew any of that.

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Posted: Dec 29th, 2010 at 06:11 pm   
...yes...so true  Thanks for posting this.

my dd has an inhaler at school also, BUT the nurse told me if she had eaten food she was gonna epi her....because the epi- works for both.

better safe than sorry......

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Posted: Dec 29th, 2010 at 07:37 pm   
We need to link the story: When Anaphylaxis Looks Like Asthma

[SilverLining]

 Posted: Dec 29th, 2010 at 09:21 pm   

Is this the one (pages 11-13)?

http://www.aanma.org/pdf/AnaphylaxisGuide.pdf

Inhalers won't stop anaphylaxis, but epinephrine will
stop either an asthma attack or anaphylaxis. So if in doubt,
use epinephrine and cover your bases.

Very good article.

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Posted: Dec 29th, 2010 at 09:25 pm   
My daughter has both asthma and allergies (history of anaphylaxis). She always seemed to be 'mild' for her asthma...until this past Spring when she had significant respiratory distress from her asthma. It has become a whole new world. I worry much more about her asthma now than her food allergies. She's had 3 hospitalizations this year from asthma exacerbation...unknown cause. None occurred after eating, though the doctors were very thorough in questioning that over and over.

I would not want my child to get epinephrine in place of her albuterol inhaler. She has periods (of about 2 weeks or so...then improves) where she needs her albuterol at least once a day. The pulmonologist and allergist are working hard to find a better asthma management combination, but this year is still a work in progress. If we did Epinephrine in place of Albuterol she'd have Epi shots daily for a couple of weeks.

This is definitely a gray area...not one I thought I'd be hanging around in so much. I have been away from the boards for a while because asthma has been much more of a concern for us recently.

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Posted: Dec 29th, 2010 at 09:37 pm   
My DS has been given the epi at school because his anaphylaxis looked like asthma. Asthma that wouldn't clear up + spaciness + another symptom I can't remember. Oh, maybe it was BP. This is not typical for his asthma, which is pretty mild.

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Posted: Dec 29th, 2010 at 09:39 pm   
LinksEtc---thanks so much!! That's a republication of the same story with other wonderful stuff!! I had originally saved it as a pdf, but the pdf online hasn't been accessible. I'm very grateful for that link!


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[SilverLining]

Posted: Dec 30th, 2010 at 06:36 am   

Dec 29th, 2010 at 09:25 pm, XXXX wrote:
My daughter has both asthma and allergies (history of anaphylaxis). She always seemed to be 'mild' for her asthma...until this past Spring when she had significant respiratory distress from her asthma. It has become a whole new world. I worry much more about her asthma now than her food allergies. She's had 3 hospitalizations this year from asthma exacerbation...unknown cause. None occurred after eating, though the doctors were very thorough in questioning that over and over.

I would not want my child to get epinephrine in place of her albuterol inhaler. She has periods (of about 2 weeks or so...then improves) where she needs her albuterol at least once a day. The pulmonologist and allergist are working hard to find a better asthma management combination, but this year is still a work in progress. If we did Epinephrine in place of Albuterol she'd have Epi shots daily for a couple of weeks.

This is definitely a gray area...not one I thought I'd be hanging around in so much. I have been away from the boards for a while because asthma has been much more of a concern for us recently.

I find myself in a similar situation except for the hospital, we have gone into the doctor's office following episodes, but I find myself close to saying we need the ER.

My DD is 11 1/2 and her body is changing rapidly. I wondered if hormones were playing into this sudden change with her asthma. The doctor said it doesn't. The first night it happened (in November) it scared the crap out of me! She had not had a full asthma attack since she was a toddler and now at her age, I wasn't sure what I was looking at. She woke in such distress. It had been 6 hours since her dinner so I chose to use the albuterol over EPI. The first puff made a huge difference and the 2nd continued the improvement. I spent the night in her room. The pain in her chest never cleared completely and when we saw the doctor in the am - they did everything including x-rays just to be sure. Nothing showed up and her oxygen was good. It happened a couple weeks later again. Last week she got the flu and the first symptom was her asthma flare followed by illness 2 hours later. I spoke with her allergist who said she had seen other patients with a virus that presented their asthma first.

Her peak meter is back in play. If not hormones, maybe the new shape of her chest or growth? I don't know but we are working on updating her "averages" so we have another tool to use to determine what is happening.

[SilverLining]

Posted: Dec 30th, 2010 at 06:40 am   

Dec 29th, 2010 at 05:42 pm, YYYY wrote:
I don't even leave my Dd's albuterol for people who watch my child.

I tell them that if my DD is having an asthma attack they simply need to give her an epi pen and call 911.

HTH

We are all in different yet similar situations. My DD has both as well. Our allergist has warned me that it is her belief that my child will need both EPI and albuterol to save her life in the event of future anaphylaxis. She has warned me to be sure we have both medications. EPI first, 911 and then Albuterol as needed to keep her airways open. She also has told me to make sure to carry the spacer too as that is the best way to get the albuterol where it needs to go.

My DD carries both meds at all times.

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Posted: Dec 30th, 2010 at 08:27 am   
We are in a similar situation. My DD hasn't needed an inhaler for years. We had even stopped carrying the inhaler with us. Recently I decided for us to start carrying it again, but I felt unsure as to how we/she would know the difference between a sudden onset of asthma or anaphylaxis.

I feel clearer about this now. Thanks for posting. I am going to bring this up to her allergist at our next appointment for further clarification.

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Posted: Dec 30th, 2010 at 09:46 am   
http://www.thenewstribune.com/2009/03/08/650722_parents-seeking-millions-against.html

This article is about a girl who died at school from asthma attack. She had an epi pen, but it was not administered.

Her parents claim the school was unprepared to handle an emergency such as this.

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Posted: Dec 30th, 2010 at 10:29 am   
My son only has very occasional asthma. When he has had it, it has come on with illness and very gradually. if DS had sudden, severe breathing trouble I'd epi him. If he had gradual asthma symptoms coming on I would assume it was asthma and give him his inhaler. If that didn't work very, very quickly, within a few minutes, or if he got any worse I'd epi him--this is what our allergist told us to do. When he is away from home I want them to epi him for any breathing issues unless I tell them ahead of time that he is having asthma and that he is on his inhalers. Even then I caution them that if they think it is a reaction and not asthma or if the inhalers don't work asap they should epi and call 911.

If there is any chance DS ingested an allergen then I"m going to lean more to thinking ana but if DS has not eaten anything or there is little to no chance he was exposed to an allergen I"m going to lean more to thinking asthma.

It is tricky. I think that article--'when ana looks like asthma' is *excellent*.

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Posted: Dec 30th, 2010 at 07:21 pm   
I think too that part of managing asthma is getting people who are caring for our kids to take it seriously. So many people don't realize that asthma can be deadly. I often add, remember an asthma attack means the person is not breathing properly! That requires prompt attention.
After the situation with the girl in the link above, we added epi pen to ds asthma action plan.

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Posted: Dec 31st, 2010 at 06:42 am   
My DS's initial reactions before LTFA were diagnosed were mis-diagnosed as asthma during 2 ER visits.   

However the ER doctors did give epinephrine when he got there to stop his "asthma" attack.


Thank you XXXX for starting this important thread!

[SilverLining]

Posted: Dec 31st, 2010 at 09:59 am   
Like YYYY's DS, my DD almost NEVER has any asthma symptoms.

The two exceptions are during illness and during any allergic reaction.


Problematically, however, sometimes this is also environmental allergens, which can make it hard to judge what's what.

This is also a good reminder that we do still need to carry an inhaler for her, even though she so seldom needs it. I'll need to get a new script. Thanks!

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Posted: Dec 31st, 2010 at 10:24 am   
That link was so heartbreaking. I think there are a lot of things that stand out but just one is that the school staff didn't do CPR. Also, disturbing to me is that they told her to calm down or some such thing in order to get her to take the inhaler. I think it is a common misconception by people who do not have asthma that those who have it panic when asthma starts and they should just 'calm down' and then they will be able to breath better. This may have *some* truth to it but certainly did not in this case. This article does scare me. I can't be sure but it sounds like her had asthma that was not well controlled. What I have read is that asthma has a much higher fatality rate than food allergies and is the more dangerous condition. I feel a lot more worried about my son's FAs but even with his mild asthma supposedly statistically asthma is more dangerous for him.

That story really bothers me. It's horrible! Most of us do not have emergency plans that say to epi in case the inhaler does not work. Even though our allergist *told* us this he did not put it in writing.

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Posted: Dec 31st, 2010 at 10:26 am   
I'm also thinking we are lax in using the peak flow meter. Asthma sneaks up on me and DS very rarely but would not if we were doing peak flow daily as a habit. I'm not sure that it would make any difference in cases like this where there is such a sudden, severe attack.

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Posted: Dec 31st, 2010 at 10:41 am   
i know the thread is about when asthma looks like anaphylaxis, but I worry so much about proper treatment and people taking asthma seriously. when I googled looking for the article about the girl, I found so many stories about kids dying unnecessarily from asthma that was not taken seriously. one was a british child whose teacher knew and was too busy to call 911 and who said "he'll have to wait".

anyway, i've been wishing that we could re term concussion with brain bruise. asthma with compromised breathing

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Posted: Dec 31st, 2010 at 12:13 pm   
I feel troubled that the similiarity between asthma and anaphyaxis isn't more common knowledge. Even though I think my DD's allergist was exceptional, the need to regard an asthma attack as anaphylaxis wasn't something told to me as part of "standard operating procedure." I ASKED how I should distinguish an asthma attack and anaphylaxis because I was so scared about reading of a number of children who died because they seemed to be having an asthma attack, received their inhalers, and the need for an epi pen wasn't recognized at all or until too late. Only once I asked, did I learn how impossible it is to distinguish the two conditions. The PP's experience with ER doctors TWICE mistaking anaphylaxis for an asthma attack highlights the difficulty. Allergic reactions and asthma attacks generally are no stranger to ER drs.

I would like to see these standard action plans revised to make it very clear that anaphylaxis can look like an asthma attack. I also would like to see this information part of the "welcome packet" of standard information given to parents of children with both anaphylaxis and asthma.

I would add my DD's asthma is very well-managed at this point. She gets albuterol prophylactically per her action plan with the start of a cold and has even started making it through her colds without difficulty. That makes it easier for me to leave people with instructions to treat her asthma attacks as anaphylaxis and give her an epi pen. I do use common sense, as I imagine others do, too. If DD gets too short of breath running up a mountain trail, I think albuterol, not epi pen.

[LinksEtc]

Thanks for bringing that over SL!

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Linking to our related threads:


Connecting "FA Action Plan" with "Asthma Action Plan"


Standard Protocol for "Asthma Action Plans"
(Page 2 has a pic)