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Cough-Variant Asthma

What is Cough-Variant Asthma

Some children with a persistent cough have a condition called “cough variant asthma.” This means that we believe that the child is coughing because his or her breathing tubes (bronchi) are reacting to irritation by squeezing in to a smaller size, just like in asthma. Children with cough variant asthma do not make the wheezing sound that we usually hear in children with ordinary asthma, though. This can make it difficult to diagnose the condition, and very often children with cough variant asthma have been through a number of other diagnoses or treatments. Parents of children with cough variant asthma usually find that regular cough and cold medicines don’t help their children, and of course antibiotics don’t help either. Cough variant asthma can be a very frustrating condition.

Once of the most important clues to learning that a child has cough variant asthma is that these children very often get a cough with every cold or upper respiratory infection (URI). The cough usually lasts for much longer than the original infection. Like children with regularasthma, children with cough variant asthma usually have other “triggers” that can set off a cough. These triggers can be things in the environment like smoke, dust, pollen, animal hair and dander, dust mites, roaches or many other things. Often weather changes can also be triggers. Children with cough variant asthma often cough more at night, which can be very disruptive for the child and the family.

What is the biggest concern?

Most parents of children with cough variant asthma are mainly worried about the child’s comfort and rest. The cough is distressing to the child and to those around him or her. It is also important to be sure that we’ve ruled out other conditions that can cause coughing, such aspneumonia or allergies.

 Cough-Variant Asthma treatment

Very often, the first step in treating cough variant asthma is the same as the first step in making the diagnosis. Your doctor may ask you to try a short-term airway relaxer (bronchodilator) such as albuterol (Alupent®, Ventolin®, Xopenex® and others). These medicines are given by inhalers or nebulizers. You can read our Aftercare Instruction onAdministering Inhaled Medications. Please be sure to use these medications exactly as prescribed. We typically prescribe these medicines to be used regularly every four or six hours for a set period of time. This is especially important when we are trying to make a diagnosis of cough variant asthma – if we only use the medicines intermittently, they will not work and we may miss the diagnosis.

If the medication works, we have made the diagnosis of cough variant asthma. Your doctor will probably instruct you to keep the inhaler or nebulizer ready to use at the first sign of a cold or cough. Again, be sure that once you start the medication, you continue it on a regular schedule (usually every four or six hours) for a set period of time (often 1-2 weeks). You may also want to keep a “cough diary” for a few months, writing down what was going on just before your child develops a prolonged cough. This can help you and your child identify the triggers and avoid them if possible. It also helps you and your child decide when it’s time to start using the medication. In more severe cases doctors sometimes recommend maintenance medications such as inhaled steroids (FloVent®, Vanceril® and others), or medicines called leukotriene modifiers (Singulair® and others).

Other things you can do to help include running a humidifier in your child’s room. Please be sure to change the water every day to prevent mold from growing in it. If your child develops afever, please let your doctor know. You can use acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) to control fever in children over 3 months. Check with your doctor about using it in younger babies. Fever is not dangerous, but it can make the child uncomfortable. If your child seems comfortable there is no reason to give any medication just for fever.

Many children with cough variant asthma go on to develop more obvious symptoms of regular asthma, such as wheezing. It might be a good idea to read our Aftercare Instruction and Child Health Topic on asthma to get some ideas of what to look for.

When should I be worried?

Cough variant asthma is frustrating and sometimes frightening. Children often develop coughing spells that are quite severe, and they may vomit at the end of a spell. These things are normal and will get better as you treat the condition. Sometimes a cough can be a sign of more severe illness, so watch out for the following:

  • Fever
  • Chest pain that lasts for more than half an hour following a coughing spell
  • Color change during or after a coughing spell, such as bluish or pale skin
  • Wheezing (whistling sounds during breathing out)
  • Coughing up mucous or phlegm (“flem” or “flame”)
  • A raspy or hoarse voice
  • Pulling in of the skin over the ribs, breastbone, or collarbone when breathing in

If any of these things occur, please call your doctor right away.  If your child seems to be having significant trouble breathing, or can’t speak in full sentences, please call an ambulance or go directly to the emergency room.

Other points of concern

Because the cough is so disturbing, many parents want to give their children other medications. Please be sure not to use over-the-counter or prescription cough or cold medicines – these can make matters worse by giving your child a high heart rate, making his or her mucous dry and thick, and making him or her fussy or cranky. In the past, some doctors used oral albuterol syrup (Alupent® or Ventolin®) in children with cough variant asthma. This does not work and can make children very jittery.

Other Conditions that Might Be Present with Cough-Variant Asthma

As we mentioned, many children with cough variant asthma turn out to have regular asthma. This is more likely if you have a family history of others with asthma. You will want to work together with your doctor to identify signs and symptoms of regular asthma, and to change the treatment as needed.

Many other things cause children to have a cough. Many children develop a persistent cough following a viral infection such as a cold, sore throat, or the flu. We do not know the exact cause of this kind of cough, and there is no really good treatment for it. You can read our Aftercare Instructions on “post-viral cough.” Some children develop an irritation in their throats or upper airways that causes them to keep coughing to try to get rid of it. The repeated coughing can produce more irritation, making the cough even worse. This can be a very difficult cycle to break. This “irritative cough” is one of the few times that we recommend the use of a powerful cough syrup containing codeine, just for long enough to stop the coughing and break the cycle of irritation. Please never use a codeine-containing cough syrup without checking with your doctor.

In some cases children cough in reaction to stomach acid coming up the esophagus. This condition is called “GE reflux,” “GERD,” or “heartburn” (if there is pain with it). The acid can cause throat or lung irritation and coughing. If you find that your child’s cough is noticeably worse after eating or when first lying down to sleep, or if s/he spits up a lot, your child may have this condition. It is fairly easy to treat with medication.

Pneumonia can cause a persistent cough in children. Pneumonia usually has a fever with it, and children appear tired and ill. Children with pneumonia often spit up mucous or phlegm, though you may not see it in younger children who tend to swallow it. Please call your doctor if you are worried about pneumonia.