A Mom writes:
My 7-year-old daughter was diagnosed this week with cough-variant asthma (allergist did lung test, allergy testing and chest x-ray). She had had the chronic cough since July 2012 but every time we went to the pediatrician she had either an ear infection or sinus infection. Does this go away with time? I have found only a little information on this type of asthma.
Her medications include: Flovent HFA 44mcg inhaler-2puffs 2 two a day, Fluticasone prop spray 50mcg–1 spray each nostril, Proair HFA 90 mcg inhaler-albuterol-as needed.
I’m wondering what we can do so that eventually she can be off medication, if that is possible and what nutritional routes we can pursue. Generally we are pretty healthy eaters. Thank you so very much.
Thanks very much for writing. Cough-variant asthma is kind of obscure, and it’s a shame your daughter had to suffer for so long before it was diagnosed. Pediatricians often struggle with patients’ asthma even when the classic symptoms are presented, but better late than never, and I’m pleased to have this chance to weigh in. This is the way we describe it in our book, which you should buy and keep at your bedside as your general reference.
“[S]ome asthmatics never wheeze during attacks but only cough. They suffer from so-called cough-variant asthma, which occurs when inflammation and bronchoconstriction are concentrated in parts of the airways, not spread generally throughout them as they would be in what might be deemed “normal” asthma. Think of them as ‘sleeper cells’ that can provoke general trouble for the whole body, as the patient is wracked with extended coughing episodes. The coughing is the body’s effort to expel these local troublemakers, as if they were actual physical entities, such as dust or particles of dirt. We must treat to control the underlying inflammation as we would with the more familiar wheezing.”
Your doctor is doing a good job from the looks of it, and certainly give it time, but if problem persists here are a couple of other ideas.
The challenge is to get the inhaled corticosteroids to all the little nooks and crannies where there are outposts of inflammation and bronchoconstriction. This is difficult in a child’s airways because the small airways are really small. Oral steroids will do the trick but for many reasons we don’t want to use it. One alternative is to use montelukast (Singulair), which blocks leukotrienes—mediators that are released from mast cells along with histamines. Another idea to discuss with your allergist is the possible use of something called QVAR, which is a small-particle inhaled corticosteroid, and might be added to the current regimen, and if there is improvement, he might experiment with taking one of them away.
While I have no special ideas on diet, some good news: As your daughter grows, so will her airways. That is why cough-variant asthma tends to diminish with time. Keep us posted.
Dr. Paul Ehrlich