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Tuesday, August 25, 2009

Weekly asthma q&a: will expired meds still work? What is extrathoracic obstruction?

Every day at we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Question: Will the medication work even though the expiration date has already been reached

My humble answer:

Great question. You will find the answer by clicking here. I write about theophyllin in this post, but the same rings true for all asthma medicines. While most asthma meds lose potency after so much time on the shelf, they are not harmful if used. However, if you do use expired meds, you should know that they may be less potent.

On rare occasion I've found expired Ventoiln inhalers stuffed inside the couch cushions or under the bed, and I have still used these even though I knew they were expired. However, Ventolin has a nasty taste too it when it's expired, kind of like rotten mints.

Bottom line, you are better off tossing expired meds in the trash and getting new ones.

Question: can a 14 month old baby be given Salbutamol via spacer.has a very bad cold and a lot of congestion... wheezing...has a very strong family history of asthma. just wondering how many puffs and is it allowed can it be any harm, for a 14 month old. her siblings have it...just can't remember, at what age was first given to them.

My humble Answer: It sounds like you have plenty of experience with asthma, and your hands full with a sick 14 month old. Still, I'm sure most asthma experts would agree with me that you should never give any medicine to a baby with out first consulting your physician. If he (or she) has already prescribed it for the child, great. But if not, you had better call.

That said, according to the package insert for albuterol, "Safety and effectiveness in children below the age of 12 years have not been established."

Regardless of that little warning, Salbutamol (otherwise known as Albuterol) is prescribed often for children under 12 for use in the hospital and for home use. In fact, I have given this medicine to my own asthmatic child when she was less than a year. So, to answer your question, yes Salbutamol is safe for a 14 month old baby.

The dose is usually the same as it is for adults, which would be 0.5cc of the solution if you give a breathing treatment, and 2 puffs for the inhaler. You can read about the medicine at

Side effects are rare, however from my own personal experience giving this medicine to children I notice they have a tendency to become hyperactive following it. I usually joke that if the child is running around the room shortly after being given this medicine you know it worked.

The ideal way to give the medicine to get the optimal dose to your child (according to studies) is with the inhaler using an aerochamber with mask. You can read about this device and how to use it over at

Question: what does it mean to have extrathoracic airway obstruction?

My humble answer: That is a great question. This refers to an obstruction of the trachea, either above or below the vocal cords. It usually occurs in children because they have narrower airways. The most common type of extrathoracic obstruction we see in the emergency room I work in is croup, which causes swelling around the vocal cords and causes the child to have a barky cough that sounds like a seal, or a constant noise on inspiration called stridor. It can also be caused by an object like a hotdog getting stuck in the trachea, cancer around the trachea, tonsillitis, or other process. According to our site, "Stridor may indicate an emergency and should always be evaluated immediately by a health care provider"

(To read more about extrathoracic airway obstruction you can check out this link.)

If you have any further questions you can

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