phlegm and allergies

[ljoan]

9 yr old daughter has a chronic productive cough for past 5 yrs.  She had pneumonia 3X before age 3. She had up and low resp problems during this time.  CF test neg.(done twice and not even boarderline)  None of the asthma meds helped.  At age 3 1/2 outgrew respiratory issues.  She was well and did not cough for 12 months.  At age 4 1/2 she started coughing again.   The cough is sometimes clear , somtimes white or sometimes yellow.  Sometimes kind of lacy. She usually gives 1 cough or no cough and out it comes. It is about the size of a quarter. Allergic to dust mites, dogs and cockroaches.  The allergist sent out her sputum and it came back neg. Recently pul. tested for Immune  problems(neg.), Lung capacity normal. The pul said she either has asthma or possibly bronchiectasis. Wait CT b/c radiation.He put her on Asmanex 250. After several months it didn't help. A 2nd opinion from dif. pul said I could stop Asmanex so I did.  2nd Pul said it may be allergies.I have been keeping a journal and recording the times and amounts of phlegm.  Most days were 3-6 times a day she expelled phlegm.  After 3 wk elimination diet of wheat and dairy, expells phlegm 1-3 times a day so there is an improvement.  She clears her throat and sound raspy a lot. She will cough phlegm at dif times of the day. Sinus xrays normal, no ear problems. Sneezes 1-3X almost every morn. Protonix for 3 weeks to see if GERD. Added a dry cough to prod. cough during this period.  Albuteral does seem to help some but inhaled steroids do not.  The ENT said her sinus look good.  Her comprehensive metabolic panel & CBC normal. Could this be allergy related since there is an improvement with elimination diet?  She NEVER coughs at night.  We live in Atlanta - very high allergy problems here.  She acts very healthy except for this cough. Not sickly at all.

[National Jewish Health]

Although this coughing is chronic in nature, it does not appear to be affecting her daily life.  It is not keeping her up during the night.  It is not keeping her from her normal daily activity and does not appear, from this description, to be associated with any other major part of your daughter's life.  The tests of the upper airway (sinus x-ray) would indicate this is not an infection of the sinuses.  The lung function testing, lack of coughing with activity and poor response to asthma medications would suggest this is not asthma.  It is not CF.  Without a chest x-ray, it is possible that there is a cause coming from the chest, but the description above would suggest otherwise.

This cough could be due to allergy.  Possibly.  Allergy, not likely to food, could cause upper airway drainage that can create this cough.  Keeping a diary might or might now help define a specific exposure.  Atlanta is a high dust mite environment and this could be the cause of this problem.  The source would be upper airway drainage.

Could this cough also come from a psychologic basis?  Yes, this is also possible, but such a diagnosis should not really be considered before ruling out specific organic causes.  I would suggest continuing to work with your pulmonologist to make sure there is no specific organic cause, including getting an x-ray of the chest, before moving to other tests or therapies.