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Premature Infants with Asthma

Dear Dr, Kagen,

I have a set of 9 month old triplets. The smallest at birth had to have a c pap for breathing for 36 hours. He has since been diagnosed with asthma. We just spent 36 hours in the hospital receiving around the clock hand held neb treatments of albuterol and cromolyn and i.v. solu-medrol.

The x ray showed a mucus plug in the upper left bronchi. We have been doing hand held nebs at home for 6 weeks and the wheezing and cough is no better. we are to see a pediatric pulmonologist. What would cause this condition and how do we prevent it from reoccurring.

thank you,

Sharia S.

Dear Sharia,

Thanks for asking about asthma therapy and wheezing in your 9 month old triplet. As you are aware, I am unable to give any specific medical advice over the Internet, but I can answer some of your concerns generally.

Premature infants who require ventilation and C-PAP at birth tend to have ticklish, hyper-reactive airways sometimes for a very long period of time. The breathing passage ways, or bronchi, produce mucus to humidify and to protect the linings of the bronchial tubes. In asthma patients and in premature infants this mucus is thicker and stickier than normal. This allows it to become stuck in the airways and to form what we doctors refer to as "mucus plugs". As the premature infant grows, the tendency to form mucus plugs grows less and less.

All of the medications mentioned in your e-mail to me are very effective and safe in treating infants with inflamed airways. The albuterol helps to open the airways and the steroids reduce the mucus production while decreasing the inflammation in the lungs as well. Cromolyn sodium is a very good medication designed to prevent the lungs from being hyper-reactive.

If your child has been found to have a mucus plug in the left lung which has remained there in spite of continued use of the bronchodilators and steroids, then the child's symptoms will continue until the plug comes out either on its own or by having a medical procedure called bronchoscopy.

I hope this brief information is useful to you and your family. You have been given an overwhelming responsibility as the mother of three. Try to keep your sense of humor. It is more fun to laugh than to cry, and you have reasons for both!

Good luck.

Steve Kagen, M.D.
Allernet.com