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Respiratory Disorders (Expert Forum)
Asthma ?
Answered by
This forum is for questions and support regarding lung and respiratory issues such as: Allergies, Asthma, Bronchitis, Colds - Flu, Chronic Cough, COPD, Cystic Fibrosis, Emphysema, Fibrosis, Lung Abscess, Nasal Polyps, Pleurisy, Pneumonia, Sarcoidosis, Sinusitis, Tuberculosis.
Asthma ?
by viet-vet, Jun 01, 2004 12:00AM
My 9yr. old daughter had the flu in jan.2004. She got better but it seemed like the cough would come and go. Then she started waking up at least 3 times a night with a coughing spell that would last from 15 minutes - 1hour each time. They also occured several times during the day. We took her to the doctor and she diagnosed it as probable asthma.My daughter was given albuterol,2 puffs twice a day and as needed, 5mg. zyrtec once a day,singulair 5mg. once a day,nasonex two sprays each nostril once a day. She still had the night time coughing spells. She had two different types of coughing. One was a dry hacking cough, which one puff of albuterol would stop. The other was congested sounding and the albuterol didn't have any effect on it. Hot tea helped better than anything for the wet cough. We switched doctors and the new one ran several test. A pulmonary function test was normal. Blood work was normal. The doctor upped the zyrtec to 10mg. and we added 3grams of vitamin-c per day. The night time cough stopped. When we ran out of zyrtec the cough returned. Any type of physical exertion brings on a coughing spell. My daughter is tired of not being able to ride her bike, run etc. There is never any wheezing with the cough or shortness of breath. We had cats in the house and they have been removed and we have cleaned the house from top to bottom. We have removed green and red peppers from her diet because they seemed to cause a problem. Should we press the doctor to recomend alergy (allergy) testing ?
Doctor's Answer
by National Jewish, Jun 09, 2004 12:00AM
, Jun 09, 2004 12:00AM
Asthma varies from person to person. The symptoms of asthma are chest tightness, coughing, shortness of breath, and wheezing. Wheezing is the most common symptom. However some people only cough. Nighttime coughing spells like you have described are not unusual. Each person with asthma could have only one of these symptoms or a combination of any of these symptoms, including all four of them.
With asthma the basic problem is chronic inflammation along with tightness of the airways of the lungs. This inflammation increases the sensitivity of the airways to a variety of things that make asthma worse. These asthma triggers vary from person to person. For some people allergies cause more asthma symptoms, but for other people allergies do not cause asthma symptoms at all. Having allergy testing done will clarify if this is a problem for your daughter. Exercise is a common trigger. Also asthma tends to be worse during the night, especially when postnasal drip is a problem. Please read our What Makes Asthma Worse MedFact at http://www.nationaljewish.org/medfacts/worse.html for more detailed information identifying your triggers and minimizing your exposure to them.
Viral infections like the flu can cause inflammation of the airways of the lungs. This inflammation can cause coughing. After the flu is gone, it is possible for the inflammation to linger. This inflammation can last for several weeks. Sometimes this inflammation may linger for 3 to 6 months. Eventually the inflammation will go away, and then the coughing will stop. This is called reactive airways disease (RAD) and behaves a lot like asthma. On a simple breathing test, called spirometry, this may not show up. This inflammation often clears more quickly when it is treated with an inhaled steroid medicine that is used to treat asthma.
When this continues, it is generally considered to be asthma. Testing can be helpful to show if your daughter’s cough is due to RAD or asthma. Generally testing starts with a simple breathing test called spirometry. This test provides detailed information about how your daughter’s lungs are working. It will show if there is obstruction in her airways. To really test for asthma this test may be repeated after using a rescue inhaler, like the bronchodilator albuterol that your daughter is using. This measures how much the bronchodilator helps her lungs by reversing the problem. When there is a 20% increase the test is positive for asthma. However it is possible for this test to be normal when a person with asthma is not having breathing problems.
An exercise challenge is a test used to determine whether or not exercise-induced asthma (EIA) is the problem. Your daughter would walk or run on a treadmill or ride an exercise bicycle. Before and after this exercise spirometry is checked. If the spirometry drops by 20% after exercising the test is positive for EIA. If your daughter’s doctor determines that she has EIA, the bronchodilator inhaler albuterol can be used 10 to 15 minutes before exercise. This pre-treating will quickly open the airways and prevent asthma symptoms during exercise. Exercise is a common trigger for asthma. For some people it is the only thing that causes asthma symptoms.
When exercise isn’t the only asthma trigger or albuterol alone doesn’t stop the asthma symptoms during exercise, then the asthma is treated on a regular basis to keep the inflammation under control. Albuterol works on the tightness, but does nothing for the inflammation. An inhaled anti-inflammatory medicine will decrease the inflammation. This may stop your daughter’s dry hacking coughing spells during the day and while riding her bike or running. Since her congested, wet, nighttime cough has not been effected by the albuterol, it may be due to a problem other than asthma. It is great that you have been able to recognize her 2 different types of coughing.
Postnasal drip is drainage from the nose and sinuses dripping down the back of the throat. There could be several reasons for this drainage. One reason is an allergy. A second reason is a non-allergic, non-infectious inflammation in the sinuses that can linger after a cold or the flu that she had in January 2004. A third reason is chronic sinusitis. Postnasal drip can cause a congested, wet cough as a result of irritation of the throat and lungs. Your daughter may experience the postnasal drip as a constant feeling of mucus at the back of her throat. Typically this is worse at night when she lays down to sleep. Generally this irritation feels the worst when she wakes up and gets better as the day goes on.
The fat content in dairy products can thicken mucus. Generally eating dairy products with less fat content is helpful. Drinking plenty of water will help to thin the mucus so that it moves more easily. As long as your daughter is not on a fluid restriction she should be drinking 6 to 8 8-ounce glasses of non-caffeine fluid daily. Throat clearing can irritate her throat and make it sore. When she feels the need to clear her throat she should sip some water to clear the mucus.
An antihistamine, like the Zyrtec® (cetirizine), can dry up the postnasal drip and stop the coughing as it did for your daughter. Although this may be the only treatment that your daughter needs to control the postnasal drip, here are some other suggestions. A decongestant like Sudafed® (pseudoephedrine) can thin the postnasal drip and decrease the swelling so it drains easier. A combination antihistamine-decongestant will do both. Check with your daughter’s doctor to see if Zyrtec-D® (cetirizine /pseudoephedrine), a combination antihistamine-decongestant, would help her more. Often an antihistamine and decongestant are taken only when the postnasal drip gets bad. It may be more helpful to take the antihistamine and decongestant on a regular basis. Singulair® (montelukast sodium) helps when the irritation is due to allergies.
A nasal wash helps remove mucus and germs from her nose and sinuses. This can temporarily decrease the postnasal drip and lessen coughing. It is most helpful when done daily before using any nasal spray. A prescription antihistamine nasal spray, like Astelin® (azelastine), helps when the postnasal drip is due to allergies. When the postnasal drip is thin and watery Atrovent® Nasal Spray (ipratropium bromide) may help to dry this up. A prescription nasal steroid spray, like Nasonex® (mometasone), decreases mucus production by decreasing the inflammation of the nose and sinuses. This may prevent the postnasal drip and coughing. A nasal steroid spray does not provide immediate relief of symptoms. It may require several weeks of routine use to become effective. Sometimes it takes the antihistamine, the decongestant, and the nasal wash followed by the Atrovent® Nasal Spray (ipratropium bromide), and the nasal steroid spray ALL used routinely to keep the postnasal drip from bothering your daughter. Please read our Nasal Wash MedFact at http://www.nationaljewish.org/medfacts/nasal.html for more information about this technique. Share this information with your daughter’s doctor to see if she would benefit from this daily treatment.
With asthma the basic problem is chronic inflammation along with tightness of the airways of the lungs. This inflammation increases the sensitivity of the airways to a variety of things that make asthma worse. These asthma triggers vary from person to person. For some people allergies cause more asthma symptoms, but for other people allergies do not cause asthma symptoms at all. Having allergy testing done will clarify if this is a problem for your daughter. Exercise is a common trigger. Also asthma tends to be worse during the night, especially when postnasal drip is a problem. Please read our What Makes Asthma Worse MedFact at http://www.nationaljewish.org/medfacts/worse.html for more detailed information identifying your triggers and minimizing your exposure to them.
Viral infections like the flu can cause inflammation of the airways of the lungs. This inflammation can cause coughing. After the flu is gone, it is possible for the inflammation to linger. This inflammation can last for several weeks. Sometimes this inflammation may linger for 3 to 6 months. Eventually the inflammation will go away, and then the coughing will stop. This is called reactive airways disease (RAD) and behaves a lot like asthma. On a simple breathing test, called spirometry, this may not show up. This inflammation often clears more quickly when it is treated with an inhaled steroid medicine that is used to treat asthma.
When this continues, it is generally considered to be asthma. Testing can be helpful to show if your daughter’s cough is due to RAD or asthma. Generally testing starts with a simple breathing test called spirometry. This test provides detailed information about how your daughter’s lungs are working. It will show if there is obstruction in her airways. To really test for asthma this test may be repeated after using a rescue inhaler, like the bronchodilator albuterol that your daughter is using. This measures how much the bronchodilator helps her lungs by reversing the problem. When there is a 20% increase the test is positive for asthma. However it is possible for this test to be normal when a person with asthma is not having breathing problems.
An exercise challenge is a test used to determine whether or not exercise-induced asthma (EIA) is the problem. Your daughter would walk or run on a treadmill or ride an exercise bicycle. Before and after this exercise spirometry is checked. If the spirometry drops by 20% after exercising the test is positive for EIA. If your daughter’s doctor determines that she has EIA, the bronchodilator inhaler albuterol can be used 10 to 15 minutes before exercise. This pre-treating will quickly open the airways and prevent asthma symptoms during exercise. Exercise is a common trigger for asthma. For some people it is the only thing that causes asthma symptoms.
When exercise isn’t the only asthma trigger or albuterol alone doesn’t stop the asthma symptoms during exercise, then the asthma is treated on a regular basis to keep the inflammation under control. Albuterol works on the tightness, but does nothing for the inflammation. An inhaled anti-inflammatory medicine will decrease the inflammation. This may stop your daughter’s dry hacking coughing spells during the day and while riding her bike or running. Since her congested, wet, nighttime cough has not been effected by the albuterol, it may be due to a problem other than asthma. It is great that you have been able to recognize her 2 different types of coughing.
Postnasal drip is drainage from the nose and sinuses dripping down the back of the throat. There could be several reasons for this drainage. One reason is an allergy. A second reason is a non-allergic, non-infectious inflammation in the sinuses that can linger after a cold or the flu that she had in January 2004. A third reason is chronic sinusitis. Postnasal drip can cause a congested, wet cough as a result of irritation of the throat and lungs. Your daughter may experience the postnasal drip as a constant feeling of mucus at the back of her throat. Typically this is worse at night when she lays down to sleep. Generally this irritation feels the worst when she wakes up and gets better as the day goes on.
The fat content in dairy products can thicken mucus. Generally eating dairy products with less fat content is helpful. Drinking plenty of water will help to thin the mucus so that it moves more easily. As long as your daughter is not on a fluid restriction she should be drinking 6 to 8 8-ounce glasses of non-caffeine fluid daily. Throat clearing can irritate her throat and make it sore. When she feels the need to clear her throat she should sip some water to clear the mucus.
An antihistamine, like the Zyrtec® (cetirizine), can dry up the postnasal drip and stop the coughing as it did for your daughter. Although this may be the only treatment that your daughter needs to control the postnasal drip, here are some other suggestions. A decongestant like Sudafed® (pseudoephedrine) can thin the postnasal drip and decrease the swelling so it drains easier. A combination antihistamine-decongestant will do both. Check with your daughter’s doctor to see if Zyrtec-D® (cetirizine /pseudoephedrine), a combination antihistamine-decongestant, would help her more. Often an antihistamine and decongestant are taken only when the postnasal drip gets bad. It may be more helpful to take the antihistamine and decongestant on a regular basis. Singulair® (montelukast sodium) helps when the irritation is due to allergies.
A nasal wash helps remove mucus and germs from her nose and sinuses. This can temporarily decrease the postnasal drip and lessen coughing. It is most helpful when done daily before using any nasal spray. A prescription antihistamine nasal spray, like Astelin® (azelastine), helps when the postnasal drip is due to allergies. When the postnasal drip is thin and watery Atrovent® Nasal Spray (ipratropium bromide) may help to dry this up. A prescription nasal steroid spray, like Nasonex® (mometasone), decreases mucus production by decreasing the inflammation of the nose and sinuses. This may prevent the postnasal drip and coughing. A nasal steroid spray does not provide immediate relief of symptoms. It may require several weeks of routine use to become effective. Sometimes it takes the antihistamine, the decongestant, and the nasal wash followed by the Atrovent® Nasal Spray (ipratropium bromide), and the nasal steroid spray ALL used routinely to keep the postnasal drip from bothering your daughter. Please read our Nasal Wash MedFact at http://www.nationaljewish.org/medfacts/nasal.html for more information about this technique. Share this information with your daughter’s doctor to see if she would benefit from this daily treatment.
Member Comments (2)
by ozark, Jun 05, 2004 12:00AM
i would...i would also have her checked for sinusitis...my daughter had a cough that was more prominent at night...i insisted she have sinus films and she was diagnoses with a sinus infection...she took antibiotics and the cough went away.....good luck
