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Ask David L. Hill, MD, FAAP Your Own Ques...
David L. Hill, MD, FAAP
David L. Hill, MD, FAAP, Doctor
Category: Pediatrics
Satisfied Customers: 416
Experience:  Adjunct Assistant Professor of Pediatrics, UNC Medical School. Vice President, Cape Fear Pediatrics.
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Can I give my 3 1/2 year old delsym while she is on Orapred and Xopenex

Resolved Question:

she has been on these medications for 4 days now, but even after just giving her xopenex in the nebulizer she still has a barking cough while she is trying to sleep. The dr said it is viral induced asthma, but being medicated why is she still coughing. Im worried it could be something more. No fever, just stuffy nose and coughing through the night. Even with xopenex every 4-6 hours and oral orapred tablets for 4 days. Can I give her delsym to help her sleep, or will that not do anything.
Submitted: 8 years ago.
Category: Pediatrics
Expert:  David L. Hill, MD, FAAP replied 8 years ago.
Hi, Dr. HIll here.
It sounds like your daughter is having a pretty significant asthma attack based on what you've said. If her breathing is labored I would certainly have her evaluated tonight. If not it might be worth having her doctor see her again tomorrow to see why this attack isn't breaking after four days of steroids. We no longer recommend Delsym (dextromethorphan) in any child under age six years: it doesn't work, and the risk of side effects is significant. It is even a less good idea to give to children with asthma, for whom the cough reflex is an important means of clearing excess mucous from the lungs. We do recommend a teaspoon of honey for children over age 12 months, although for asthma I'm not sure it will do any good. The best thing would definitely be to have her evaluated again in the next 24 hours or sooner if she is in any distress.
Customer: replied 8 years ago.
She was evaluated earlier today. The doctor said she was still wheezing and to keep her on the orapred for another 2 days. She is still coughing as I write while she is trying to sleep. I just assumed that these medications would make the coughing settle down by this time and concerned that she has been misdiagnosed.
Expert:  David L. Hill, MD, FAAP replied 8 years ago.
You know, it sounds like the diagnosis is sound, although it may be time to check a chest x-ray if that hasn't already been done. We certainly do see asthma attacks that go on well over four days even on appropriate medication. I'm happy to hear she's been seen already today - it sounds appropriate. She may need to be checked daily until this thing clears up. In general a child can take up to 7 days of Prednisone before needing to taper the dose slowly rather than stop suddenly.
Customer: replied 8 years ago.
So basically what she is going through right now is an asthma attack related to a virus she is having? That is what I am assuming viral induced asthma is. I was not told to taper the dose of the orapred just to stop after 2 more days...will that be harmful to her? Finally, do you think I should take her to a specialist since I am still pretty confused as to what to do for her and steps to take when she gets like this? My dr has never suggested a chest x-ray either. Thank you for all your help.
Expert:  David L. Hill, MD, FAAP replied 8 years ago.
Let me say first of all that, not having examined your child, I cannot make a diagnosis myself. I can say that many children with asthma have exacerbations when they get viral illnesses and that those exacerbations sometimes last well beyond four days. Up to seven days of steroids do not require any taper, but longer courses usually do. The management you describe to date sounds pretty routine, and I would not think a specialist would be needed just yet. Often when a cough is going on longer or more severely than the underlying disease would suggest a chest x-ray can be helpful, but your daughter's doctor can decide whether it's indicated based on her history and exam; it may not be helpful in this case.
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