Side Effects of Asthma Meds

Archived Q&A and Reviews

Behavior changes in 2 year old due to asthma medications?

Feb 2004

Our 2 1/2 year old son has asthma (mild, according to the doctor/asthma specialist). He is now on 3 medications: Flovent (inhaled), Albutorel (inhaled, or through the nebulizer if needed), and most recently Singulair. The teachers at his day care, and the director of the day care, have recently told us that for the last 3 weeks he has been acting very impulsive, and very aggressive toward the other children, hitting them, running up to them and pushing them in an aggressive way, scratching their faces. While he is a very active boy, he is not typically agressive, so they were concerned, as are we. The director asked if any of his medications had changed lately. He started on the Singulair in early December, which would have been about 3 - 4 weeks before they started noticing his behavior changing. Has anyone noticed their child's behavior changing on any of these asthma medications, or heard of this? (Our son's behavior was terrible the one week he was on Predizone, but we're not putting him on that again.) He's also waking up almost every night with night terrors. And, his behavior with us has also gotten more difficult. We're also looking of course into other factors/ reasons for this behavior. A concerned parent

I am an asthmatic, and have been taking flovent and albuterol (as needed) for many years. They have never caused any problems. I have tried (twice), and hate, Singulaire. It disrupted my sleep and gave me nightmares. I can't say whether it otherwise affected my mood or reactions, but I would suspect it as a prime candidate for causing your son's night terrors (though those also are age appropriate) and maybe even his acting out. Try cutting it out and seeing if your son improves. For what it is worth, Singulaire is only recently FDA approved, and has not been standard treatment historically. Leslie

Hi, I am not sure what your relationship with your child's doctor is like or what your insurance plan is. But have you talked to an allergy/! asthma specialist about your son's condition and the necessary medications? I take my son to Dr. James Nickelsen, and I think he is really an awesome doctor. He specializes in allergy and asthma treatments and is excellent with children. If you are uncomfortable with the medication that your son is on, it might be worth your time to talk to Dr. Nickelsen and see if he really needs to be on three medications. His phone number is (510) 644-2316. Amy

You do not say how frequently your son is on albuterol, but this sounds like pretty heavy artillery for mild asthma. Singulair should not have any noticeable side effects and is considered pretty safe. I don’t have any experience with flovent, but I can tell you from experience that albuterol causes terrible behavioral side effects.

Our son, now 3 ½, had his first asthma attack at 13 months. He was hospitalized 6 times from that age til the age of 2 ½. His asthma is more in the moderate to severe range, and is virally triggered (meaning any time he has a cold he is at risk of having an attack and we have to step up all the meds). If you don’t yet know, it is really helpful to identify the trigger(s) of your son’s asthma.

Our son was put on albuterol in the beginning, and the first few times in the hospital he literally banged his head nonstop on the metal bars of the crib. It is terrible stuff. His behavior when he was on it was unmanageable, and we finally told our pediatrician we needed to try something else. He then switched him to xopenex, which is a milder form of albuterol. It seems to be less well- known, and may not be covered by all insurance (it is probably more expensive). It made a world of difference. Though his behavior is still more difficult and aggressive when he is on it several times a day (that’s only when he is sick) it is way better than albuterol!

We also use pulmicort, and inhaled steroid, every other day (up to twice a day when he is sick), and singulair every day.

Prednisone, as you found out, is the worst of all as far as nasty side effects go! (and it tastes AWFUL) We avoid it like the plague. However, when he is really really sick and nothing else is working, it is the only thing that can prevent a visit to the ER. You should always have some in the house just in case. I would definitely recommend seeing more specialists—especially an allergist (Jim Nickelson is wonderful and knows a ton about asthma) and a pediatric pulmonologist (Nancy Lewis in Walnut Creek is great). There are other meds and combinations that they may suggest for yo! ur son. In my experience almost anything is better than albuterol! I could go into lots more detail, so please feel free to contact me if you’d like to talk.

Best of luck to you. It’s a long and sometimes scary road, but it usually does get easier and better—most kids do outgrow the frequency and severity of the attacks as they grow. Tracy

My 4-year-old son has been on Albuterol (as necessary) and Flovent (daily, as an asthma attack preventive) for quite a while. When he was 2 and experienced quite a few attacks, I was often sending an inhaler with Albuterol to preschool with him with instructions to dose him every four hours. The teachers started asking me if they could hold off giving him the treatment until after naptime, because they said when they gave him the Albuter! ol before naptime, he wouldn't sleep. They felt it hyped him up. I didn't see this at home. When he was in the midst of an attack, I found he couldn't sleep unless he had the inhaler because of the difficulty breathing. But I've heard other people say that Albuterol can hype up a child. And I haven't noticed anything with the daily Flovent. I don't know about Singulair. Gwynne

Two of my kids used albuterol when they were wheezing, which was usually after a cold, throughout grade school. They called it ''the shakey medicine''. I did notice they were a bit more hyper afterwards, and their pediatrician confirmed that albuterol can have this effect. GO

My now 5.5 yr. old s! on has had asthma since he was 8 months old. He is currently and has been on both Singulair and Pulmicort (daily controllers) for the past two years. He has never been on Flovent.

We have never had behavior problems with either the Singulair or the Pulmicort. However, it is true that when he is having an asthma attack and is on Albuterol and/or Prednisone, his behavior gets more wild and agressive. Those medications also can both cause a lack of appetite and upset stomach, as well as difficulty sleeping which might not help behavior issues. Even though you didn't really ask about the Prednisone issue, I thought I'd share our experience. We have had many doses of prednisone for severe attacks both in and out of the hospital. I feel that even though the prednisone can cause temporary behavior problems, it is very important to take it when advised by the doctor.&n! bsp; It definately helps a severe attack and minimizes the risk of hospitalization or worse. If you want to talk more, please feel free to email me. dylyn

Unfortunately, I have more experience with pediatric asthma than I would care too. My son is on a regular inhaler of Flo- vent and Albuterol (we too have the means to give it to him through an inhaler and through the machine). So, while we have not had any experience with Singulair, we do have almost 4 years of experience with the other two medications your son is on.

In the beginning, we did notice some change in our son's behavior. He was generally more 'wound up' and not particularly agressive, per say, but defiantely more 'hyper'. Our son has been hospitalized 3 times with severe asthma attacks, which resulted in lot! s of time spent at Children's Hospital. We've seen asthma specialists, gone to asthma parent support groups, etc. The jist of what we have learned, both through doctor's information and through watching and living with a child with asthma, is that in the beginning, as the child's body gets used to having these steriods in their system, they do tend to be more wound up than normal. Two of the pediatricians in our practice told us that the amount of steriod in the medicines are very minimal, just enough to open the airways. I can tell you that it DOES get better as they get bigger, and now, 4 years later, we are begining to only need to be on the inhalers when he has a cold.

With regard to Prednisone, we've been on that numerous times as well, and there are EXTREME reactions in our son's behavior thanks to that steroid. And, the reactions have lasted for a couple of weeks at a time (even after being all done with the Prednisone), and his behavior has been very affected. I can also tell you that the albuterol is the medicine, for us, (and the doctor confirmed this to be true in most cases) that causes our son to be more hyper than usual. I've been told that it has the same affect for adults as well.

So, my guess would be that if he's showing some more hyper behavior than usual, it is probably due to the albuterol.

Something to watch for- does he behave this way for the hour or two after havign a dose of the allbuterol? If so, that's probably your cause. (this is the reaction we see in our son) And if you're giving him an albuterol treatment before bed, that could possibly be causing night terrors, (it never did for our son but it was pretty hard for him to go to sleep right away on those nights). But, 2 and half is pretty normal to be having night terrors anyway. That's about the time my son started having them.

As a preschool teacher, my thoughts are that there could be several reasons for his behavior as school. I'd be happy to answer any questions I can for you on asthma or preschool, if you like. You can email me at the address below. Good luck to you guys, I know how scary and nerve-racking it is to get used to the whole asthma situation. It feels so big and scary in the beginning! Hope I was able to give you some advice. Jessica

Our daughter got her first asthma attack when she was 12 months old. Her condition stabilized when we started her on daily Flovent, Singulair, and hydroxyzine at 17 months old. She does albuterol by nebulizer only when her asthma acts up. In October 2003 her pulmonologist thought that we could ! try lowering the Flovent from twice a day to once a day at 42 months old if she continued to be stable. We decreased it at 40 months and now (she is 42 months old) she does Flovent just once a day, Singulair, and no hydroxyzine. Because she started her meds at such a young age and before any attempts to put her into a school setting, we didn't have much to compare to, but I will say that she is just now playing better with other kids (at your son's age, she used to shove constantly and it was very stressful to have her in a group setting), can listen to instructions, and can sit in circle time. It also took her till now to potty train. It's hard for us to separate growing pains and personality from medication effects, but we did suspect that the medication was affecting her behavior. The reason we decided to cut her Flovent down as soon as was safe was because a friend who's a family practice doctor told us that his 3 year old son, who had just started Flovent and Singulair for asthma, was not concentrating as well as he used to in preschool, and did better when they cut his Flovent down to once a day. (Fortunately, his asthma is stable on the lower dose.) Neither of us has tried to eliminate Singulair, since doctors tend to think it has no side effects, but we can say that we have seen a difference with Flovent. We are speculating in our daughter's case, but it seems pretty clear cut in our friend's son's case. carol