Asthma: The Cough That Won’t Go Away

While the majority of coughs stem from a viral upper respiratory infection, and therefore will get better with time, a chronic cough shouldn't be overlooked. We never want to over-diagnose asthma, but we don’t want to miss it either. Doctors will make the diagnosis based on family history, present illnesses, physical examinations, and sometimes laboratory data and ancillary tests.

Asthma is a type of sensitivity. A child with asthma has hyper-reactive airways, meaning that certain stimuli (dust, cigarette smoke, mold, cats, cockroaches, etc.) will trigger a reaction in the lungs. We've known for a while now that the reaction involved a constriction of the lung’s bronchioles, or small airways, causing sufferers to feel a tightening of their chest and to have difficulty breathing. But there is also an inflammatory component to asthma, and this contributes greatly to the disease process.

Certain conditions run together, and people with asthma will often also have dry skin, eczema, and/or allergies. Sometimes a baby will develop all three at an early age. Researchers are investigating ways to prevent what’s called the “atopic march." Perhaps in the near future we can actually prevent asthma from coming out in a child with a strong family history of it, if he is already showing signs of eczema and allergies.

Testing for Asthma

When evaluating a child for asthma, family history is important, as the condition often (but not always) runs in the family. But a physical exam is even more important, as doctors need to listen for wheezing in the lower airways. Sometimes, however, you can have a normal lung exam and still have asthma. Conversely, a young child (usually less than 1 year old) can have certain viruses that cause wheezing, so not all wheezing indicates asthma.

There is a test for asthma called spirometry, or pulmonary function tests, but these tests require effort from your child, so it usually can’t be performed until he is at least 5 years old. For the younger child, your doctor will have to make a clinical diagnosis based on whether his cough is “tight,” non-productive, or lingering. Other signs of asthma may be a nighttime cough, or coughing from exercise.

Other common causes of a chronic cough include sinusitis, post-nasal drip, viruses, pertussis (whooping cough), walking pneumonia, and acid reflux. It is normal for a common cold to leave behind a mild cough for up to 14 days, but if your child is suffering with a cough for more than 2 weeks, he should be re-evaluated. Sometimes an x-ray may be necessary.

Treatment

Asthma is treated with bronchodilators, medicines that open the lungs. Albuterol is the most common (also called Proventil, Ventolin, Proair, Maxair) and is given orally, inhaled in a pump, or from a nebulizer machine. The oral method has the most side effects. The pump needs to be used in conjunction with a spacer device in order to get the medicine to the lungs. And the nebulizer can be used at any age, but takes a good 15 minutes to set up, administer, and clean.

Other medicines that are anti-inflammatory include Singulair (a mild medicine that is not a steroid and can actually help with allergies as well) and steroid-based medicines such as Pulmicort, Flovent, and Advair. Scientific studies show that only a trace amount of steroid medicine is absorbed into a child’s system if the pump or nebulizer is used correctly; your doctor will discuss the risks and benefits of each medicine they prescribe.

Cold medicines, including Robitussin, Dimetap, Sudafed, Triaminic, Tylenol, and Motrin, are not effective for asthma, and you run the risk of encountering side effects or overdose. So please stay away from these medicines!

If asthma is left untreated, it will progress and can get quite serious—even deadly. If your child ever exhibits any signs of respiratory distress—their chest wall or stomach is going in and out too rapidly—go to the emergency room immediately. When it comes to trouble breathing, a doctor needs to conduct a face-to-face assessment immediately.

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