my 2 year old won't stop coughing

my 2 yr old has had a cough for over a year- docs suspect asthma- he is on Montelukast and blue inhaler when bad_ is on his 2nd lot, double dose of antibiotics in last 6 weeks prior to that steroids- the Montelukast did help although seems to be going backwards now- last night over 4 hours he had 1/2 hours rest from coughing and the white mucas he was bringing up (vomiting too) was a massive amount- docs say could be infection again so on antibiotics and to carry on using his medication for asthma- could there be another reason for this? the inhaler doesn't seem to help so I am not convinced it's all to do with asthma. even if he has a snivel it sets him off for week worth of continuous coughing choking and vomiting ......

[David Tinkelman, M.D.]

The first order of business should be to determine with reasonable certainty if your son has asthma and, if he does, to optimize his asthma therapy.  It is not always possible for physicians to be absolutely certain of the diagnosis in a child as young as age two and that is why I use the words “reasonable certainty”.  In a circumstance like this where the cough has been present for a year and the response to asthma therapy has been sub-optimum, raising doubt about the diagnosis of asthma, efforts to rule out other diagnoses would be quite appropriate.

My recommendation then is that you speak with his primary physician, express your doubts about the diagnosis of asthma and your concern that another lung disease might be causing your son’s problem, and request that he/she assist you in requesting a second opinion from a Pediatric lung specialist (pulmonologist).  As your son’s strongest advocate, it is quite appropriate that you make this request in his behalf.

Good luck.