Beclovent (Beclomethasone)

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Other names: Beconase AQ

ASTHMA TREATMENT IN CHILDREN: MILD ATTACK
Let us take the case of Julie. When I first started treating Julie for asthma she was only 4, and at this age it does take a little longer to master the technique of using the inhalers. Her asthma had first presented with a particularly severe attack, and her parents were worried about this happening again. It appeared on closer questioning that Julie had been having minor wheezing episodes about every 10 days, so I started her on an Intal spinhaler, which is used to prevent any attacks developing. A capsule is inserted and punctured by sliding the base of the spinhaler. The powder in the capsule is then inhaled.
While Intal is effective at reducing the frequency of asthma attacks, it is still possible to suffer with wheezing – especially in Julie’s case when she had a cold. I tried her with a standard pressurized Ventolin inhaler which she didn’t like and couldn’t co-ordinate breathing in with pressing the canister. In fact most of the dose was lost in a cloud of vapour down her nose! Julie thought this was horrid and I realized quite quickly that if I didn’t try a different method I would soon lose the willing co-operation of my patient! Furthermore, using the pressurized inhaler hadn’t made the slightest difference to her peak flow readings. Julie had a special junior model and her readings were normally exactly 250, reduced to around 200 when she became wheezy. On repeating this after the pressurized inhaler the readings did not alter, indicating that none of the medication was reaching her lungs.
As she was well practiced in the use of a spinhaler it seemed a logical step to try Julie on a rotahaler, since this also involved the use of a capsule. This meant that she did not have to co-ordinate the breathing in with any other action, and all it required was two slow, deep inhalations to breathe in the powder. On re-checking her peak flow levels after treatment I found they had returned to their normal level of 250. The rotahaler comes in a compact little box which also carries six rotacaps. I stressed both to Julie and her parents that it was essential to make sure that the rotacaps were replaced when used. Several times I have heard of children who come to use their rotahaler only to find they have no spare capsules.
Julie’s parents asked me at what stage she should start to use her rotahaler, and whether she should continue her Intal spinhaler as well. It is a cardinal rule in asthma that the earlier an attack is treated the quicker it will settle. I therefore advised them to give her a rotacap as soon as they suspected a wheeze to be starting. This can then be repeated every three hours if necessary. As Intal is designed to prevent attacks developing, once wheezing is established there is little point in continuing it, so it should be left alone until the asthma has subsided.
One of the most important aspects of the treatment of asthma is that the child should have faith in the treatment and be certain that it will relieve them. I always ask the girl or boy what their thoughts are about the particular type of inhaler they are using, as sometimes it throws up unexpected reactions. Julie’s comment about the pressurized inhaler was mainly about its taste and not the fact that it came down her nose! Also she liked the taste of the powder in the rotacaps which was surprising because to me it tastes foul! In fact Julie was very happy with her treatment, as the rotacap was easy to use and it was something to show off to her new school mates.
*44/211/5*