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Asthma

Croup and maybe asthma?

12/03/2008

Question:

My son is nearly 5 years old and since he had started school at age 3 he gets very often cold like symptoms and then develops a very dry persistant cough this cough then becomes croup and he has to use his nebuliser and pullmicort steroid and rectodelt steroids to calm the case down.The problem is that he is getting it week in and week out but the persistant cough is an every day thing now.Last week he coughed sooo much that he had to stay for 4 days in hospital.I have been told that he could have asthma but hten again he is never short of breath We have a history in my family for Hayfever and also asthma so I wouldnt be surprised if the diagonisis happens to be asthma.But what confusses me is that he hardly seems to be out of breathe like asthmatics go through.When I asked the hosp Dr he said its not asthma but cant really give it a name.Which has confused me even more now.Please help me understand what my son is suffering from as it is hard to understand what it is and what could be the cause.I would have rathered it be called asthma than ?.He has missed alot of days of school cause the cough is so persistat it is impossible to let him go into school like that and he is also missing out on playing at the park etc cause of this cough.Just hearing him makes my heart explode cause it really is a horiible cough that just doesnt give in especially at night time and the morning it seems to be worse.even when it starts getting better during the day the night is always problamatic.please help thanks in advance

Answer:

The most common causes of chronic/persistent coughing in otherwise healthy children are asthma, chronic drainage from the nasal passages (due to allergies or sinus infection), and stomach acid splashing backwards up the esophagus (gastroesophageal reflux.)  There are a variety of much less frequent culprits, as well.

In a child who has a track record of clear worsening with colds, a family history of allergy & asthma, AND whose cough improves with medications like nebulizer treatments and steroids, asthma would rise to the top of the "suspect" list.  

Asthma is an illness in which the airways are nearly always a little inflamed, even when the child appears well.  When something more comes along to cause a little more irritation (a "trigger" - colds are the most potent example of this), the inflammation gets even worse.  Several things then happen in the airway - the muscles around the breathing tubes can tighten (bronchospasm), the lining may swell more, and the airways may get clogged with mucus.

The symptoms that all this causes can vary from patient to patient. If there is so much bronchospasm and swelling that the room for air passage through the airways gets very small, then a squeaky sound may be heard (wheezing), and the patient may obviously have to work extra hard to get air in and out of the lungs (look breathless,) in addition to coughing.  The patient has "classic" asthma symptoms.

There are some patients with asthma, however, who never sound wheezy, and mostly cough.  The coughing can become fairly severe at times, can sound like "croup", and can get to the point that oral steroids (the most powerful anti-inflammation medication we use for asthma) has to be used to calm things down.  If this happens repeatedly, or if the cough keeps recurring in a milder form, then daily asthma medications (often an inhaled steroid) can be very helpful.

Sometimes hospital doctors (who may only see a patient once or twice) are a little hesitant to make a formal diagnosis of asthma - especially in a child who only coughs.  Because it requires recognizing an ongoing pattern of illness (not just one or two bad episodes), the doctors who might be able to best help you are the ones who have seen your child most frequently for these symptoms.

If the coughing does not improve with asthma treatment, or there are other factors which don't "fit" with the diagnosis of asthma, then your doctor may begin looking for another (or additional) cause of the problem.

For more information:

Go to the Asthma health topic, where you can:

Response by:

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