Can you have asthma without wheezing?

[KarenV]

My son was recently diagnosed with asthma but has no wheezing.  When he was three he developed a pleural effusion after we were told a small pneumonia had resolved.  We were told this was probably due to inflammation caused by the infection.  Now he is seven.  He got a small pneumonia (one or two crackles before coughing) which we thought had been resolved by antibiotics as his fever went away and he felt much better.  His cough did not go away after another 2 weeks, and in fact sounded wetter,  so we went back to the doctor.  She said both lungs were full of mucus and she felt inflammation caused him to be unable to clear this out.  He began nebulizer treatments three times per day but it still has taken another couple of weeks to resolve the cough.  She is now diagnosing him with asthma.  She is recommending that we restart the nebulizer any time he develops a cough as she believes exposure to infections agents is his trigger.  We are also supposed to bring him in within a day of restarting the nebulizer so that he can be monitored more closely.  He never complained of tightness in his chest or difficulty breathing and has had no wheezing (other than a little wheeze during forced expiration).  It sounds like his inflammation is more distal but I thought asthma involved the upper/larger airways.  There is a lot of asthma in my husband's family but they all have more frequent episodes (asthma attacks) with wheezing and a dry cough.  Is two episodes of inflammation after pneumonia in seven years, with no wheezing, asthma?

[National Jewish]

NO is the answer to your final question “Is two episodes of inflammation after pneumonia in seven years, with no wheezing, asthma?”  But, that does not mean that your son has or does not have asthma.  This is much more complicated.  Asthma is an inflammatory condition of the lung, including the small airways.  While it usually has wheezing, it does not start that way in many people.  Not everyone with asthma wheezes.  Some people only cough.  While it is usually fairly frequent, it can be an isolated event.  Asthma is fairly easy to diagnose with pulmonary function testing in children who have reached school age.  From what you have described, it is not clear that your son has or does not have asthma.

[KarenV]

The only tests they are doing now are Peak Flow readings.  Over the last 10 days his best has been 250.  He is 7 years only but 57 inches tall and 80 pounds.  His doctor says she expects him to improve over the next few weeks and we are to go back if he doesn't get up to 320.

[Soco]

I read about your 7 year old.  I have an 8 year old with similar issues.  He was diagnosed with asthma by the pediatrician.  I ended up taking him to a pediatric specialist in asthma/allergies.  He did a blood test which showed that my son had "Mycoplasma."  He was treated with BIAXIN.  We were told that he probably had this condition in his nose, but it went undiagnosed and therefore, untreated.  Once Mycoplasma settles in your lungs, it is hard to get it out and SOME children end up having Asthma as a result.  After my son was treated with the Biaxin he was taken off of the nebulzer.  He was given Singulair once a night and an inhaler called "Maxair" to be used before PE and sports.  The doctor said that this fall and winter we would see if any viruses would then cause asthma.  He had two viruses, which we managed by increasing his Maxair to 2 or 3 times a day for a couple of days.  Now recently he caught another virus that affected more seriously.  However, the doctor still has not diagnosed him as having asthma.  Right now the diagnosis he is using is "reactive airway disease."  My son is 8 years old, 52 inches tall and 68 punds.  His best peak flow is 250, which by the standards of this specialist, are "beyond excellent."  When he got sick this week he went down to 150.  I don't understand why your doctor thinks your child needs to be at 320 to be healthy.
This time, my son is being treated with oralpred for 5 days, zythromax for the mycoplasma.  He was also given a different inhaler called combivent.  This inhaler helps to reduce the need to cough.
Hope this is helpful.  I am hoping very much that my son doesn't develop asthma.  My advice to you is to get a second opinion from a specialist.

[sherrivet]

A related discussion, Asthma Or Not was started.