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.
Dear Mom,
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
Dr. Paul Ehrlich — Thank you so much for the information on Cough-Variant Asthma. I was not diagnosed with asthma until my mid-20’s when I was in college. I had trouble breathing in many of my classrooms. Over the years, my asthma has steadily worsened to the point where I had that same nagging Cough-Variant Asthma. (Yes, I was on various asthma treatments the entire time.) For years my doctors encouraged me to work at home if at all possible. I just brushed them aside, thinking I could handle working. Well, 10 years later, I noticed I was coughing a lot, if not most of my days. So, I decided to keep track of my asthmatic cough for one year. During that full year, I was “sick” a total of 9 months out of 12! I finally heeded my doctors’ advice and started working from home. Unfortunately, after five years of working at home, I am on disability for my asthma. It can take anywhere from 8 weeks to 6 months to get the cough under control. Last year, GERD was diagnosed as a part of my CVA! So, another med to add to my regimen.
I hope that 7-year-old will outgrow her CVA and not have to go through what I go through each year. Good luck to the family.
Thanks again for your information.