Hi A.,
First, inhaled steroids are used to treat inflammation of the airways. Bronchodilators come two different ways: short-acting like Albuterol, or Xopenex, and long-acting like Flovent or Serevent. Advair is a combination drug with a fixed dosage, which makes it hard for a doctor to adjust the dosage. Short-acting bronchodilators are to be used sparingly and not relied upon as the sole method of breathing for an asthmatic. That is an asthmatic out of control...if they are living on albuterol. Giving young children inhaled steroids and nebulizer treatments (with the same meds, just different delivery system) is typical. However, many doctors are quick to jump to the steroids without trying other things first. There are guidelines for controlling asthma, if that is in fact what your doctor is treating at this point. It is impossible to diagnose asthma in a young child based on the accepted methods of diagnosis: FEV (1) Forced Expiratory Volume because you can't get a 21 month old to do this test. So, your doctor may be treating on the assumption of asthma at this point. The hard part about steroids and inhalers and broncodilators is that they're a pain in the butt to administer. The child hates it, the parent hates the struggle, you don't know if you did it right, you're worried about side effects,etc. There is a chewable tablet for children down to age 2 and it is available in sprinkles down to ? 6 months that is not a steroid and works completely differently on asthma. It treats the root of the problem, which is inflammation. It's called Singulair and the FDA says the safety profile of this drug is comparable to placebo. It's in a pregnancy category along with birth control pills...that means it's extremely safe! It is also approved for allergic rhinitis (allergies). Ask your doctor to let you add this to your current regimen with the hopes of tapering off everything else eventually. The most effective medicine is also the one that is actually taken and that's a big question with inhalers. Also, remember, that in any bronchitis situation...coughs last a long time. Albuterol and Flovent will hype up a patient and make their appetite increase. Oral steroids, which some asthmatics have to take, are the ones blamed more for the puffy face look and increased weight gain and increased side effect profile. A short-term run of your current regimen is not to be worried about, but definitely ask about the Singulair.
I hope this helps. My second child had RSV and was diagnosed based on history with asthma. We did every treatment available with lots of anguish. Once we added the Singulair...life became pleasant again. After several years on Singulair and a change in the environment/states...he is off all meds. Maybe he outgrew it? I have 12 years of pharmaceutical sales experience.