GERD and chronic cough in 9yo

My 9yo daughter has allergies, cough-variant asthma, Bethlem Myopathy (she does well, but has weakness and fatigue).  She was recently diagnosed with reflux with a milk scan and takes 20mg of Prilosec twice a day.

She takes singulair, zyrtec, nasonex, elestat, and flovent for allergies and asthma and adds pulmocort and albuterol by nebulizer for flares (usually caused by a virus).  She has had allergy shots for 2 years which have helped a lot.

She has been coughing since Oct 4.  It started with a cold, but did not respond to pulmicort and albuterol nebs.  We tried oral steroids, but she was sleepless and crazy and we stopped.  After 9 days of non-stop coughing, we started 20mg of Prilosec and 14 days of Biaxin.  Her cough went from non-stop to occasional, but never stopped completely.  It flared on Nov 22 and we started 21 days of Biaxin thinking sinus infection.  It flared again Dec 11 from a slight cold and hasn't really calmed down since.  

She has had normal PFTs during the worst of the cough, two normal spirometries in addition, a normal chest xray, and everyone with a stethescope says her lungs are clear.  Normal bloodwork for blood count, metabolic labs, thyroid, pancreas, h pylori, celiac, kidney, and liver.

They tell me that the "next step" is an endoscopy and the pulmo will do a bronchoscopy since she'll be out for the endoscopy.  I hate the idea of it, so the fact that I'm willing to put her through it says that this has been terrible and going on too long and it's time to get some answers.

So my question is what might we be looking for at this point, from a GERD/GI perspective?  What might be going on that she is still coughing despite 20mg of Prilosec twice a day?  Is there anything they "should" be doing with the endoscope that might not be routine, but would be a good idea at this point?  Are there any other GI tests, or blood tests that might be needed to figure out how to help my coughing girl????

[Ratnakar Kini, MD]

Hi myopathymom,
Your daughter is having asthma, myopathy and incessant cough.The cough is not controlled adequately by medications. GI endoscopy and bronchoscopy are suggested----

GERD is an important cause for cough and asthma. According to studies about 35% to 90 % of asthmatics have an associated GERD.

The tests that are to be done are -
1. Endoscopy - this is normal in most of the cases. But in severe cases you may find some lesions in the food pipe
2. 24/48 hrs pH monitoring - the confirmatory test

Prilosec is a good drug. But the effectiveness may not be the same in all patients.

I would suggest that you meet a gastro for your daughter's problem.
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The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.