The Most Distressing Sound: Having an Asthmatic Child

We have just made it through another bout with our son’s asthma. If I had to guess at all the things that trigger his symptoms, I’d have to go with just about any natural phenomenon: weather changes, laughter, exercise, dust particles, nighttime. (I have actually read that chronic asthma tends to be worse at night, though I’m not sure why.) Exacerbations produce the typical wheezing in his lungs, but more noticeably a severe and persistent cough. It is his special twist on the disease, a variant that I never knew about until he was tentatively diagnosed as a toddler. It comes on most strongly when he catches one of many viruses or bacteria cycling through his classroom. The presence of a pathogen in the airways seems to constrict and inflame everything more than in a person without asthma. Unlike an acute attack brought on by short-term exposure to a trigger, which can be settled with a couple of inhaler puffs, the pathogen-related attacks last for days. And when it’s respiratory illness season, it feels like we don’t get a respite for very long.

He seemed fine at the start of last weekend, but on Sunday he started to get congested, and the cough developed on the heels of that. It increased in frequency despite the inhaler puffs, and by the evening, my husband and I knew that he would need to stay home from school the next day. We always admit this begrudgingly. Our son is six, very talkative, and clingy, and we both work full-time jobs (mostly) from home. The workday is one of our only quiet times, so having it interrupted is stressful, even more so when the interruption comes with the near-constant sound of coughing.

By Sunday night it was bad enough for us to start medicating him with the nebulizer, a little panda-shaped air compressor with a tube leading to a cup that holds liquid medication, and a mask that covers his nose and mouth—a procedure that we simply call “panda mask”. During lengthy exacerbations, we do a panda mask morning and night, and sometimes it’s a double panda: piggybacking one type of medicine onto another. This is supplemented by puffs on the rescue inhaler throughout the day, just to keep things at a manageable level. My son usually isn’t feeling too sick except for the coughing, so he will happily play and chatter while pausing to cough about every 30 seconds. We keep him busy with a book or short movie while he’s on the nebulizer.

On Monday I had to report to the office, so my son stayed home with Dad, who checked in at midday and said the cough wasn’t too terrible. My ever-present mom guilt kicked in anyway, and I headed back home a bit early to help. The kid was so happy to see me, and started jabbering so much, that his cough took a notable turn for the worse. My gladness at seeing him gradually turned into a longing to be back at my cubicle. When the coughing is profuse, my husband I can tolerate it no more than we’d tolerate nails on a chalkboard. By early that evening, we had both escaped into earbuds. I cranked up a white noise playlist and tried to play mindless games on my phone while my son watched videos. Our usual hope for respite on these nights is that he’ll fall asleep early. The harsh, dry asthma cough must be exhausting for him. But that night, it didn’t quiet until after 10:30. I was in the den, watching TV, still trying to escape.

There have been nights when we have to get out of bed more than once to administer his inhaler, or even fire up the nebulizer and make him sit up, sleepily, to take a treatment. The most stressful case of this happened a few years ago, when I took him solo on a trip to California to visit family. I don’t remember why I packed his nebulizer and medication—if he had started showing signs of an exacerbation, or if I had simply learned by then that it was better to be prepared for unpredictable triggers. In any case, his asthma flared up bad over the next few days of staying with my parents. I used up every little vial of medicine I had brought, with multiple daytime and nighttime panda masks administered. The fact that I was doing it all alone, when the baseline of traveling alone with a small child is hard enough, frayed my nerves. And the tension was magnified by doing it in somebody else’s house. Those continual interruptions to the day (and night)—coughing, medicating, coughing, medicating—were familiar to me but not to the grandparents who only saw us a few times a year. Seeing it from their perspective, and hearing the concerned tone in their voices as they asked about his regimen, reinforced the fact that my child has a chronic illness.

On Monday night I got up once or twice to give him an inhaler. I was awoken more than twice by the coughing, but it’s not necessarily helpful to medicate him every time. On Tuesday morning, it continued steadily, and I took the day off to care for him. I tried not to isolate myself too much in spite of how much the noise grated on me. I monitored his cough for a while after the regular morning meds. When it didn’t improve, I engaged our secret weapon: a bottle of leftover prednisolone from a recent urgent care visit.

Having a kid with asthma means frequent visits to urgent care or the ER. We went even more often in the first couple years before figuring out the right cocktail of home treatments. Two Thanksgivings in a row were spent in the ER, where my son got chest X-rays, hospital-strength nebulizer treatment, and Tylenol. At other times, I took him to urgent care out of pure desperation, even knowing that he’d probably had his fill of medication at home; it was just so hard to watch him suffer. In the throes of it, he is unable to finish a sentence without coughing. (And talking is one of his favorite things.) With experience, we learned the responsible amount of time to monitor him at home for responsiveness to the standard meds before taking him to a doctor. His pediatrician introduced the magical formula of dexamethasone crushed into a spoonful of chocolate syrup.

Dex, like prednisolone, is a steroid, and we try to use those sparingly. They also require a fresh prescription every time, which means an office visit to any available clinic. I got the latest batch of prednisolone (and a $330 bill after insurance) from an urgent care because my son’s exacerbation happened on a Saturday outside of his regular pediatrician’s hours. The doctor on call had administered some at the clinic and sent us home with extra, thank goodness, in case that first dose didn’t work well enough.

So, this week, I used it. His cough improved noticeably within two hours. He was well enough to go to Bricks and Minifigs for some new LEGO pieces, which meant he got what he wanted and I got to leave the house. I started to relax; our house was back to a normal level of quiet. There is no sound more distressing than one produced by your kid’s suffering. I know that his dad and I both feel aged after dealing with a round of asthma attacks. And I’m sure that his kindergarten teacher missed him.

He was back at school on Wednesday.