On November 4, 1995, a 6-year old white female child was presented to my office, apparently asymptomatic, with her mother asking if I could treat her daughter to play and participate in gym class without relying on the use of an inhaler. I had treated this child on January 5th and 12th, 1995, for a stiff neck after getting hurt while playing with her older sister. I had also treated her mother and five other family members for various conditions and was considered their family physician.

A more detailed medical history revealed that on january 19, 1990, at the age of four months, this child was brought to Dr. A, a Chicago city physician, with dark circles around her eyes, dry cough and a low grade fever. She was diagnosed with bronchitis and given a 10-day
supply of antibiotics. The mother stated that her child was fine after the first few days of taking the medication.

In July 1991, during mid-summer, while at the age of two, the child developed a 104-degree fever. She was then taken to Dr. B, another Chicago city physician, where a chest X-ray was taken and she was diagnosed with walking pneumonia. Again, the child was given 10-day supply of antibiotics for the infection. Dr. B also prescribed Preventil syrup, with instructions to take the medication “as needed,” particularly during the changes in season (i.e.,spring, fall, etc.). This medication was continued through July 1993. It should be noted that the mother complained of the medication causing extreme drowsiness in her child which decreased the child’s active time during waking hours.

In May 1994, at the age of four years, the patient developed a severe cough. Again, Dr. B was consulted and informed the parents that the child had experienced an asthma attack. It was at this time that the child was diagnosed as having asthma and was given two treatments of saline and H20 mist. She was also started on two medications simultaneously: Aerobid (Flunisalide) in the form of a 7 gram inhaler, taken three times per day, with each dose delivering 250 mcg of medication, and Preventil (Albuteral, USP) in the form of a 17 gram inhaler, taken three times per day, with each dose delivering 90 mcg of medication. Again, it should be noted that the patient’s mother told Dr. B that these medications were making her daughter very tired and sleepy during the day. Also, the mother stated she felt that her daughter was becoming dependent on the medication, as she would cry when she was active if she did not get to use the inhaler. The patient’s mother stated that her daughter would become so upset that if she was refused the inhaler, her crying would bring on an asthma attack. Dr. B offered very little comment and continued the two medications.

In October 1995, the mother took her daughter for a school physical and checkup to Dr. C, a third Chicago city physician. Dr. C took the patient off the Aerobid, but kept her on Preventil on an “as needed” basis. When the mother told Dr. C that her daughter was dependent on the medication whenever she was active and also frequently at night, Dr. C made no comment and stated that the drowsiness was a common side effect of the medication.

Upon examination in my office on November 4, 1995, the patient presented with anterior thoracics, levels T3-6, and left posterior thoracics, levels T7-9. All orthopedic and neurologic testing was within normal limits. The patient was adjusted using Standard Diversified Technique and given ultrasound over the thoracic paraspinals region with the following parameters: 1.0 w/cm2, pulsed for five minutes. My patient was put on a treatment program of one visit per week, for a three-week trial period.

On November 25, the patient’s mother stated that her daughter was able to play longer without having to resort to the use of the inhaler. At that time, another three-week treatment period was prescribed. On December 9, 1995, the mother reported that her daughter only used the inhaler before going to bed. On December 22, 1995, the patient’s mother stated that her daughter was able to participate in gym class without a problem and no longer complains about not being able to breathe. On January 14, 1996, the patient’s mother announced that her daughter had not used the inhaler for a whole week. Subsequent follow-up visits have revealed that between January 14 and March 24, 1996, the patient has had to use the inhaler only once.

In conclusion, Dr. C was informed of the child’s progress following a spring school physical and was told of the treatment the child has received and of her response. The patient’s mother states that she does not want to put her daughter back on the prescribed medications, as she feels her daughter is finally experiencing a “normal and active” childhood lifestyle.

Acknowledgments

The author wishes to extend his special thanks to Margaret M. Carroll.