Childhood asthma, allergies, or something else?

[Joanie27]

My 4-1/2-year-old has been coughing horribly at night.  In the past, her pediatrician has had me give her Zyrtec and then Albuterol sulfate via nebulizer.  I have done both of these this time and nothing is helping.  Could there be something else wrong with her besides allergies or "childhood" asthma?  When our pediatrician was out, another doc said he heard a "slight" wheeze, thus the albuterol sulfate.  She has a lot of mucous and cannot seem to "deal" with it.  My daughter "hawks" up mucous during the day and then when she lies down at night, it sounds as if it is between her nasal passages and throat.  Sometimes, it sounds as if she is going to choke on the mucous.  We have even used Singulair.  She does not cough much during the day.  I have also been told that she just cannot deal with sinus drainage.  Isn't there any other medication that docs can give to help the poor kid sleep?  Going to Pediatrician again tomorrow.  Just wondering if there are any other diseases besides asthma or allergies that sound like what my daughter is going through.  Didn't know if we should see an allergist or perhaps a pulmonologist?  Thanks

[National Jewish]

With asthma the basic problem is chronic inflammation along with tightening of the smooth muscles that surround the airways of the lungs.  Bronchospasm is the tightening of the smooth muscles that surround the airways of the lungs.  A fast-acting inhaled bronchodilator medicine, like albuterol by nebulizer, reverses the bronchospasm quickly by relaxing the smooth muscles.  The inflammation is decreased and prevented when an inhaled steroid, like the Pulmicort Respules™ (budesonide inhalation suspension) by nebulizer, is used daily.  Talk with your daughter’s doctor about this medicine to see if this helps her nighttime cough so that she can sleep.  Singulair® (montelukast sodium) helps with both the inflammation and the tightness.

When this inflammation is not controlled, it 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.  Postnasal drip is a common trigger.  Asthma symptoms also vary 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.  Coughing horribly at night like you have described is 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.

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.  A third reason is chronic sinusitis.  Postnasal drip can cause coughing as a result of irritation of the throat and lungs.  It may sound like the mucus is between your daughter’s nasal passages and her throat.  Also it may sound like she is going to choke on the mucus.  Typically this is worse at night when she lies 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.  She should be drinking 6 to 8 8-ounce glasses of non-caffeine fluid daily.  “Hawking” up mucus can irritate her throat and make it sore.  When she feels the need to clear her throat have her sip some water to clear the mucus.

An antihistamine, like the Zyrtec® (cetirizine), can dry up the postnasal drip.  However, it may make the mucus thicker and more difficult to move.  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 your nose and sinuses.  This can temporarily decrease the postnasal drip and lessen her cough.  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 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 you.  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.

[Ellis7]

The excess mucus might be postnasal drip from rhinitis or sinusitis; especially if she has nasal problems. There are nasal sprays to deal with this [Nasalcrom which is OTC, and the steroid ones like Nasonex]. Another possibility is GE reflux, or asthma; or a combination of any of the 3. There are also environmental factors [pollen, pets, mold] and food allergies.

Its time to get a referral to a pediatric allergist.

[inn0cent]

Perhaps you should have her tested for cystic fibrosis. Thick mucous and a cough, as well as chronic sinusitis from nasal polyps are both symptoms of cystic fibrosis.

[msfitz]

I could have written your post on 19Oct!  My 4 1/2 year old son has been battling the excess mucous issue for over 2 years now and it's EXTREMELY frustrating.  I just left our pediatrican of 9 years because he just wasn't helping us.  He'd say, "have him blow his nose..."  That does no good, as you know, because there's just so much of that sticky, clear mucous. It's limitless!  And we shake in our boots when he starts his coughing phase because we know no one will sleep for weeks.

I'm dying to know what you ultimately find out.  We're going for a second allergy test on Monday, Nov 8th.  We had it done when he was 3 years old but the testing was negative, although we'd read he was to young for the testing to be conclusive (even though my pediatrician swore by it).  But we're getting desperate now and have a new pediatrician and are going to a new allergist. I'm sure we might end up down the pulmonologist route but my husband suffers from severe allergies with nasal problems so we really think that'll be the answer.

Although, we get confused about what to do as two of our four children suffer from reflux and our 9 year old still gets the croup. So there may be the reflux-reactive airway disease thing going on here too.  Also, our 9 year old had the severe coughing at the same age and has gotten better as she's gotten older.  

Please post other notes as you can to let us know what you find out about your daughter.  I'm certain we can learn from it.  We'll do the same!

Thanks so much.