We had Monkey’s pulmonologist appointment today. We met with the nurse practitioner.
They did the usual pulmonary function tests. Monkey had been off his asthma meds, except for Singulair, for several weeks. His results looked “normal” except for the “flattened inspiratory loop” which is characteristic of VCD. I asked if that meant that he did not have asthma at all, and she said she couldn’t tell just from one test, but that it certainly meant that he did not need the asthma meds for day-to-day functioning, or for his current level of athletic involvement. She said the only way to tell for sure would be to give him nebulized albuterol and see if his results got even better. Monkey wanted to do this and see what the results would be, so we did that. He did improve by 20% in one area. Over 10% improvement with the albuterol means that he does have asthma, but given the very good results pre-albuterol, his asthma is so mild that it will probably never bother him unless he gets into very competitive sports.
She explained to Monkey what an asthma attack would feel like compared to a VCD attack (the tightness would feel like it was in his chest, and he might have a deep, from the lungs, cough that he would have trouble kicking).
Looking at his eyes, nose and mouth, she said she did see evidence of allergies, so that he should either stay on the Singulair or switch to Claritin (or if necessary he could use both). Since he is doing well on the Singulair, we will probably just keep him on that at least through the summer, though I will do some more research on the pros and cons of each. She said that there were not long-term side-effects to Singulair the way there are for things like the corticosteroids.
So, he is staying off the Advair, no longer using the albuterol and intal inhalers prior to exercise, and does not need to have the albuterol with him whenever he exercises. But we will send an albuterol inhaler to (overnight) camp just in case he does start having real asthma symptoms there.
One anti-side-effect we are hoping for now that he is off the Advair is a little more growth. (Monkey is still under five feet tall.) Advair can temporarily slow a child/teen’s growth. In Monkey’s case, his slow growth is probably due to genetics more than the Advair (based on my own growth pattern) but it is good not having that side-effect possibly piling on top of the genetics anymore.
I asked, and she pointed me to an information sheet on VCD that we can send with his medical forms to his soccer day camps, just so someone there knows what his condition means, though he does so well controlling it, that I don’t think it will be an issue.
My only disappointment with that appointment was that their spirometry machine was not set up to measure PI MAX which we had hoped to measure today to help us know the correct settings for his IMT training. So I have to check with the speech therapist whether she can determine that well enough using the IMT device itself, or whether we need to set up a special appointment to get that done before he starts.
Monkey also had a soccer game today, and had no attacks (yay!), though we had a longer than usual half-time break due to a lightning storm passing through, which probably helped.
