Side effects of giving steroids (budecort)by inhalation

Wheezing among children is very common nowadays. Medication via inhalation is the best treatnent for this.

Two types of medication is given.

  1. Beta agonist bronchodilator ( asthalin or livolin) .
  2. Corticoid steroids ( budecort) .

The former gives immediate releif and latter prevents wheezing.

Most parents are worried about the side effects of these medicines especially steroids.

When we give the medicines via inhalation, the medicines is delivered directly to lung passages and lungs, where these are needed. Very small amoun ofthese are absorbed in to blood. Thus these medicines do not have any side effects. A number of studies have been done and the results are that steroids even if given for a prolonged time via inhalation, do not cause any side effects.



Side effects of giving steroids like budecort via inhalation for a long-time.

Letter from a mother

Dear doctor
I have a boy who is 1 year and 4 months old. He weighs 13.4 kgs and his height is 80cm.He’s an asthematic and have bin on budecort 0.5mg twice daily since he was 6 months old. He breaths heavy and suffers from frequent cold and cough. Also I have bin giving him montair4m since almost 6 months now with a gap of a month in between, as prescribed by his pediatric. There were times when he fell so ill that my pediatric had to put him on oral steroid omnicortal and told me to nebulize him every four hourly with asthalin. However currently he has prescribed my baby asthalin on sos basis.I just had a few questions. Request you to please help.
1) i wanted to know if the prolonged use of these medicines have any side effects or not. As I vaguely got to know from someone that prolonged use of budecort effect a child’s mental health.
2)Also I wanted to know if it is due to budecort that my child weighs what he does because otherwise he doesn’t eat much. Feeding his meals to him is traumatic as he simply doesn’t open his mouth even of I have a gap of 4 hours in between his meals. 3) what king of food should I include in his meals that’ll help him improve his condition.
4) will this state of asthama slowly go away with time and he’ll return to normalcy.
My husband was an athematic too in childhood but no more. Though he’s highly allergic and suffers from a constant cold.


Many children suffer from this problem nowadays. Most of these children do not have this problem after about 4 to 5 years of age.

Lot of research has been done about steroids like budecort given with nebulizer or inhaling via other methods, continuously, for a long time time. There are no certainly does not effect mental health.

Yes your child is overweight. It is not due to medicines, because if it was due to medicine, your child will have increased appetite, but you said that he does not have appetite.

You should feed your child only four times in 24 between he should have two glassses of milk., If he is breast feeding , you should try to stop that now. If he does not want to eat do not force feed him.
He should have well-balanced diet. Do look up my book on childcare at is a chapter on diet for read that. You will get an idea how to feed him.

As I said before most of these children do not have this problem when they grow up

Repeated colds and coughs

Question from a mother

My son (now 3.4 years)had ear infection this year Jan . Before tat he is prone to cold and we uaed to give allegra for 3 days; he was fine. From February

he used to get cold and infection once in a month. In april we went to ENT and she gave refil antibiotic and omni cortol steroid. The ear infection is gone.she suggested to use septilin for 3 months. She also asked us to use allegra and montair to prevent further cold which might lead to ear infection. From July 24 onwards he has been getting coldevery 2 weeks. We ended up giving allegra for 15 days in a month. Our regular pediatrician has asked us to use avamys steroid spray for 3 it safe to use formy son

In reply to motherYes all these medicines that your doctor prescribed are safe. However they will only help if the reason for repeated colds and coughs is allergy. Mostly these colds and coughs are due to repeated viral infections which a toddler gets when he/she starts going to play school.

To prevent these infections his immunity has to be increased,
1. Do not send your child to school when he is not well.
2. Give him well balanced diet.Dolook up the book easybabycare, chapter on diet.the book is available at free.

Prevention of infection of stomach and intestines

Now in India weather is very hot and with that comes  the germs (viruses, bacteria and parasites) that can cause diarrhea and vomiting. The youngest children, less than 2 years, are most vulnerable to diarrheal diseases. Fortunately if we take proper precautions we can prevent these diseases. So today we will talk about the measures for prevention of diarrheal diseases.

Prevention in infant

Breast feeding is natural protection for most of the diseases especially diarrhea. World Health Organization recommends that babies should be exclusive breast fed until 6 months of age.

Those who are not breast fed should be fed with breast milk substitute that is infant formula milk. It is important that certain precautions should be taken in preparing the feeds when formula milk is used. The bottles and nipples should be sterilized in a commercial sterilizer (follow the manufacturer’s instruction) or boiled in a pan. The water that is used for preparing the feeds should be boiled even if you are using bottled water. After boiling the water it should be cooled for less than 30 minutes (to not less than 70c) and then should be mixed with measured amount of powder. The reason is that the milk powder may not be sterile, however when it is mixed in hot water the germs in it will be killed. The prepared feed should be cooled down quickly in running cold water or in a pan of cold water. If not consumed within 2 hours it should be thrown away. The prepared formula feeds can be refrigerated for 24 hours. After taking out from refrigerator it can be warmed in a bowl of hot water and then used.

Babies can get germs from the hands of those who touch them; so those who handle them should wash their hands with soap and water or use hand sanitizer before touching them.

Prevention in older children

Using Safe water is most important to prevent diarrheal diseases. Bottled water is usually safe but be sure to check the seal that it is not tampered with. If one is not sure about the water supply then it should be boiled. If boiling is not possible then micropore filtering or disinfecting agents like iodine tablets should be used especially while one is travelling outside the country. Bottled or properly packed beverages are usually safe; again the seals should be checked.

When one is eating in restaurants and is not sure whether proper food hygiene precautions are taken in that place, then be sure that the food you eat is well cooked and steaming hot. The food items that are not cooked like salads should be avoided.

One can get diarrhea from home made food also if one does not take certain precautions. While buying food from stores check the “use before date”. The frozen food should be brought home within one hour of buying and should be placed in the refrigerator immediately. Food once thawed should not be frozen again. Raw food and ready to eat items should be kept separately. Food especially poultry, meat, and fish should be cooked thoroughly. No part of it should remain pink. Uncooked eggs should not be eaten unless they are pasteurized. Cooked food if not consumed immediately should be cooled quickly(within 1 to 2 hours) and kept in the refrigerator. Do not keep hot food in the refrigerator, as with this the temperature in the refrigerator will rise and thus bacteria will grow in the other food items. Cooked food can be kept in refrigerator for 2 days. In the freezer as long as it remains frozen, but the texture and taste will change with prolong storing. Food once taken out of the refrigerator and warmed or kept out for a length of time should not be kept back in the refrigerator.

In the kitchen the sinks, work tops and utensils should be cleaned thoroughly. Dish clothes should be washed in hot water frequently or disposables ones should be used. Hands should be washed after touching uncooked food. The knife and chopping board which is used for cutting uncooked food should be thoroughly washed. It is better to use separate knife and chopping board for cutting salads and fruits. If you are taking the cooked food to be eaten outside home then it should be transferred in a cool bag with ice trays. Lastly hand washing is must before eating. Taking above measures will keep the germs away from you and your loved ones to a great extend. 

2015 in review

The stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 23,000 times in 2015. If it were a concert at Sydney Opera House, it would take about 9 sold-out performances for that many people to see it.

Click here to see the complete report.

Guides for management of dengue fever

In an attempt to dispel myths and create awareness about the ongoing dengue outbreak in the city, IMA, HCFI and Indian Oil Corporation have released a set of guidelines for the management of the disease.

Simple Dengue Fever:

Over ninety-five percent people suffer from simple dengue fever, which is not as threatening as severe dengue fever.
In simple dengue fever there is no capillary leakage, the person requires only oral fluids, 100 ml per hour, and is advised to visit a local doctor
Additionally, the patient is recommended to drink 500 ml water at the time of diagnosis. Only those patients with dengue fever who have vomiting should be given intravenous fluids

Severe Dengue Fever:

Those suffering from severe dengue develop capillary leakage and intravascular dehydration. Also, they suffer from a rapid fall in the platelet count along with rapid rise in their hematocrit levels They will have rapid fall in platelets along with rapid rise in hematocrit levels
Persistent vomiting, nausea, extreme exhaustion and lethargy are some of the symptoms of dengue. Along with these symptoms, a victim might suffer unrelieved abdominal pain and mental irritability and confusion.
These people require close daily observation.
Dengue patients are kept under close observation and are recommended to consume 1500 ml fluids (20 ml per kg) immediately
And in case, when they cannot consume liquids orally, then intravenous fluids are a must

Formula of 20 to identify high-risk cases of Dengue fever:

If there is a rise in pulse by 20
Fall in upper blood pressure by 20
Rise in hematocrit by 20 percent
Rapid fall in platelets to less than 20,000
Petechiae (red spot) count of more than 20 in one inch after tourniquet test
If the difference between upper and lower blood pressure is less than 20, then such cases should be given 20 ml of fluid per kg immediately and then shifted to nearest medical center for medical assistance

What you need to do in case symptoms are prevalent?

The follow-up tests are required to witness the rise in hematocrit and significant fall in the level of platelets.
The tests are required to be screened simultaneously.
Platelets transfusions are not required unless there is active bleeding and platelet count is less than 10,000
Keep a tab on hematocrit levels are crucial as their count decides the adequate requirement of fluids required by the body

It is important to remember the following:

Capillary leakage only occurs when the fever is on the verge of subsiding.

The initial 48 hours, including 24 hours after fever is over, are crucial, and the patient requires plenty of fluids as a sub-treatment
Signs of itching or rash usually occur post the capillary leakage period is over

When is urgent admission required?

If the patient is unable to consume or tolerate the consumption of liquids
Pregnant women

Patients with underlying comorbid conditions
Infants or elderly people
Patients suffering from uncontrolled diabetes

Prevention of influenza in school going children

It has been proved by several studies that frequent hand washing,(at  least 5 times a day) use of sanitizer, especially after touching contaminated surfaces does prevent influenza in children. Beside this, it is also advisable to immunise your children with influenza vaccine before the influenza season, that is just before winter.

Raj rani