12 yr old with chronic cough (prev asked on 2-12 but need more advice)

[brown eyed]

On 2-12-05 I asked a question. I can't find answer on website, but it was there(my frustrated looking probably), but did jot down prev. that you suggested cough-variant asthma, physchogenic cough and acute bronchitis.  The second two I don't believe to be true.  The regular physician gave up and said to see a pulmonolgist.  Long story short-came into contact with another girl same age that had this in Dec and went to allergist and started on Tessalon Perles(Benzonatate) and better in 4 weeks. We got into same allergist & he puther on Benzonatate (2oo mg) and Hydrocodone/gg Syrup.  The Hydrocodone syrup gagged her so much and increased coughing/irritation for 2 hrs after each dose that he said discontinue. She can't swallow pills and he said not to poke hole in or dissolve. He said to practice w/mini M&Ms & anything else til you learn how to swallow pills.

Frustrated.  Been 5 days since appointmt and no pills down...still same cough. She has sweats/cold for last  3 days so on Tylenol.  She also takes Prilosec from condition started Dec 27 from flu(vomiting)-acid reflux.  After reading medical book-any connection to: reflex-cough due to irritation from midde ear....intestine, hacking in nature. Stimulation from Arnold's nerve.  Can't get into pulmonolgist at St.L. Children's Hosp til mid March & considering their emergency room if can't swallow these pills. We live 3 hrs away. Tessalon doesn't come in liquid.  Other ideas?

brown eyed.....thanks

[National Jewish]

Your daughter’s sweats/cold are worrisome.  This could mean that she is getting worse rather than better.  Check with her doctor to be sure that her condition has not changed to the point where there is now another problem that should be treated differently.



Tessalon® perles (benzonatate) only comes in capsule form.  Check with your daughter’s allergist about trying the hydrocodone syrup in tiny amounts, less than 1/4 of a teaspoon.  This small amount is less likely to gag her and over time should help to control the cough.



Irritation of the ear canal can stimulate the nerve of Arnold and cause a cough.  From what you have described it is unlikely that this is the cause of your daughter’s cough.  A neurologist would be the type of specialist to evaluate your daughter further to know for sure.  It seems much more likely that your daughter’s cough is due to reactive airway disease (RAD) and/or acid reflux.



Gastroesophageal reflux disease (GERD) is the back flow of stomach contents, including digestive juices, into the esophagus or food tube.  This is most commonly called acid reflux or heartburn.  This reflux can come all the way up into the mouth and nose.  When this happens the material can be aspirated, dribbling into the windpipe and lungs.  GERD can cause the following symptoms:

· Heartburn or a sour taste in the mouth;

· Pain occurring in the middle of the chest;

· Coughing and/or choking while lying down;

· Increased trouble breathing while asleep; and

· Even no symptoms at all.  This is called “silent reflux” and it is common.



Even though your daughter has been taking Prilosec® (omeprazole), it is possible that it has not helped her cough because it is not controlling the acid reflux.  A pH probe is the best test to find out if she truly has acid reflux and/or if the medicine is controlling it.  This test measures the acid in her esophagus to see if digestive juices are coming up from her stomach.  Please read our Gastroesophageal Reflux Disease MedFact at http://www.nationaljewish.org/medfacts/reflux.html for more information about things to do to lessen acid reflux.  The pediatric stomach specialist is the type of doctor to let you know if further testing is needed to identify acid reflux and the best treatment.  Once again I suggest that you work closely with the pediatric stomach specialist to gain control of the reflux in an effort to bring a stop to your daughter’s cough.