Toddler with Bronchitis for 5 months

[MamaBerry]

I have a now 22 month old son who was diagnosed last season with what we presume is asthma based on symptoms. It seems to be viral induced. This season came around and sure enough, when he got a cold it went straight to lungs (wheezing, SOB, coughing)

We started inhaled steroid (budesonide), albuterol regimen again. Proved unsuccessful to resolve cough. Round of Orapred proved unsuccessful to resolve cough. After four months we consulted with Pulmonologist.  Switched up steriod to inhaled Flovent 44 instead of nebulizer and albuterol qid. No results. Chest x-ray and blood allergy (why not at this point) ordered and clear.

Follow up with Pulm realized no coughing at night and diagnosed with Protracted Bronchitis. Treated 3 weeks of Augmentin 500mg BID x three weeks.  Nasal and throat cultures test negative except for rhinovirus. Albuterol (qid) Combivent (BID) combined treatment resolved shortness of breath finally so dropped albuterol and combivent... but cough still persists. Follow up again with Pulm increased dosage of Flovent to 110.

Sorry so detailed, just wanted to convey that we have tried MANY approaches. He is still coughing. Albeit less frequently on some days, but still very bronchial cough. Wet, non productive. No drainage and No fevers EVER.

He has been coughing since the beginning of October from his initial cold. Anyone have a different approach? It has not slowed him down. Seems environmental exposure play a LARGE roll in how severe the cough is. Being outside and maybe even our cats :( Just ripped carpet out of room yesterday as last resort.

Any suggestions would be greatly appreciated. We are using All Children's Hospital physicians so we are looking at good care. But we are all missing something.

Thank you in advance!!

Worried Mama

[David Tinkelman, M.D.]

I am sure you are frustrated and worried after all of this time.  Here are some thoughts.  First, I think the approach to your son has been totally reasonable and appropriate.  It is likely that he has reactive airways (asthma) and that the inhaled steroid was the best way to control the wheezing and breathing difficulty.  It is also likely that the last viral infection created the more chronic cough that you are seeing.  The key questions are: does it affect his daily activity? From your note, the answer is “no”.  The second question is does it affect his eating so that he is losing weight?  It does not appear that this is the case since you are an excellent historian and did not mention this.  The third question is does it affect his sleep?  Again, you have not mentioned this.  On the basis of those three answers, I would not be as worried as you probably are and continue to use the Flovent as you are doing and stay in close contact with the Pediatric Pulmonologist.  It is likely, that your son will continue to have wheezing episodes with infections and possibly with exposure to certain allergens.  If your son is allergic, you should know that cats are a major factor for allergic/asthmatic children.  

Hope this response helps.

[MamaBerry]

It should be noted we are a non-smoking household. We don't use perfumes, our cleaners are dye and perfume free. We have cut dairy and meat out of his diet. And have tried to minimize his gluten too. I have added about 200mg of magnesium to his daily multi-vitamin/mineral supplement. And he has also been on Singulair for about a month now too.