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Asthma

Cough Varient Asthma and Medications

01/08/2007

Question:

Hello, My son is 4 and has been diagnosed with cough varient asthma. He has been on a number of asthma meds since he was 9 months old starting with pulmicort/albuterol through a nebulizer. He has had scopes, c-scans,allergy testing,a chest x-rays, and the sweat test preformed. He is currently on flovent, singular,nasonex, atrovent as needed, douneb as needed, and takes a lot of oral steroids for flare ups. Since then, we have had him to a number of doctors to try to help him. He has a horrible cough often triggered by infections and some times exercise. He does not weeze like a "typical" asthma patient. When he gets the average cold it lasts weeks. He often vomits when his cough gets bad. It is not just a normal cough. It is deep, loud and disturbing. He has been on prednisolone 3 times (which I feel is excessive) and 2 different antibiotics since 11/1/06 along with increased flovent, atrovent and the introduction of prevacid . He still has a brutal cough. We have been to the ER 2 times in the last 6 months for his asthma (excessive vomiting during a coughing spell and/or inabilty to rest between coughs). My question is if he is on all these meds and nothing helps what is the advantage of the meds? He does not resond to albuterol at all. We have had blood work done to look at him immune system. The doctors do not seem to think this is the issue since his levels are not significantly low. He stumps everyone that seems him, even his dr.`s at Cincinnati Children`s. I am just getting frustrated with giving him all the meds and him having no response to them. I understand he may always have a cough but the way he walks around when he goes through these episodes(often lasting weeks) is unbelievable to me. Any advice would be helpful. I am beginning to think I should look at other ways of treating him ie. chiropractic care, which I never though I would consider?? Thanks.

Answer:

The problem with the symptom of "cough" is that there are so many things that can cause it; further, sometimes more than one problem is at fault, and until you address all of them simultaneously, it may be difficult to get the coughing under control. Common reasons for cough include asthma, gastroesophageal reflux, and post-nasal drainage due to allergies or sinus infections. Less common causes range from problems with dealing with respiratory infections (immunodeficiencies, cystic fibrosis, cilia abnormalities), abnormal airway structures (born with or due to airway scarring), to even coughing that doesn't have a physical cause at all, but instead is related to stress. Sorting all this out can be a real challenge, and involves both testing and trials of medications. Not surprisingly, sometimes families become so skeptical that the medication is helping at all, that they gradually quit giving it. The doctor, assuming that the medication is being given, and isn't working, keeps piling on more medications, making matters even more frustrating. These issues can make things even more confusing. If your current doctors have truly been stumped, it can be helpful to seek a second opinion. The more information you can provide the new physician with (regarding copies of test reports, and as accurate at possible information about what drugs have been tried - and which help, help only temporarily, or don't help at all), the better they will be able to perhaps think of a fresh approach. Prepare, also, to repeat a couple tests or medication trials (there isn't a test out there that is ALWAYS accurate, and sometimes they need to be repeated to be "sure.") I have a lot of faith in "standard" medical care - it's not perfect, but doctors who practice it really make a priority of conducting or keeping track of studies that scientifically "prove" their recommendations are the best possible advice they can give. I would recommend that you seek a second opinion by someone in this arena, before proceeding to more "alternative" medicine approaches.

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Response by:

Elizabeth D Allen, MD Elizabeth D Allen, MD
Clinical Associate Professor of Pediatrics
College of Medicine
The Ohio State University