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Child having cough and runny nose. Diagnosed with asthma. What should be done?

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General & Family Physician
Practicing since : 2001
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Hello please help my 2 1/2yr old son has had a consent cough for nearly 7weeks now along with on and off temps and also a runny nose which is also on and off. The cough sounds horrible and irradiating and does wake him especially while sleeping, but his overall well being is quite normal. In the first 2weeks I assumed it was either a chest infection, broncoltes or the flu. I then put him on a coarse of antibotics which he finished 100% but he still had the majority of symptoms. I then took him to a doctor who prescribed him a 3 day coarse of a steroid, which he also finished and still he remained to have all of his symptoms so we returned to see another doctor who said he's chest was clear and unfortunately it is going around and it could take up to 5 to 6 weeks to clear. In the end of the 4week I returned once again to another doctor, after a couple of temps and still with the same cough, she then dianogised my son with asthma and prescribed him with another steroid to give him for 3days and also ventolin liquid to be given 3 times daily, after the third day on both the steroid and ventolin no change and my son if anything seemed worse as he had two more temps along with the worst 2nights sleep while on the ventolin liquid ( both times on the 3day steroid, the dose was given in the morning as advised by both doctors and pharmacists) I decided to not give him anymore of the ventolin until I got another opion.In the mid of the 5week I then decided enough was enough and got him in to see his doctor that has seen him form birth. I was told then that the dianogise that the previous doctor had given him was incorrect as his chest was clear and although he has a higher chance of having asthma as both his father and I had asthma and broncol asthma as children, he is still too young to be sure 100% as he cant do any type of breathing test. He then said to give it a week or two and see how he goes without any medicine and if No improvement or I get concerned bring him back within a week. I then returned in a few days as still no improvement and the coughing was getting to the stage of him nearly vomiting, we were able to see his doctor and he prescribed a twice a day coarse of antibotics which he has all most completed. He has improved slightly but still especially while sleeping has that same cough. PLEASE Help us as I'm not sure what to do and he has never had any illness that I couldn't get rid of, what should my next attempt to get him better be ?
Posted Sun, 28 Oct 2012 in Asthma and Allergy
Answered by Dr. Michelle Gibson James 2 hours later
Hi, thanks for using health care magic

A cough that has lasted this long would be classified as a chronic cough.
The most common causes are: post nasal drip, uncontrolled asthma (there is a cough variant asthma that presents mainly with cough and no wheeze), gastroesophageal reflux (this actually occurs commonly in children and they do not present with the typical symptoms but with cough which may be worse at night or laying flat, it can also worsen asthma if it is present).

Your doctor may want to do an xray to make sure that there are no obvious reasons for the cough.Hyperinflated lungs (more air than usual) may be demonstrated which would indicate asthma, a foreign body may also be seen.A sinus radiograph may also be done to check the sinuses.
Allergen testing may check if there are any specific allergens that may be contributing to his cough.

Because post nasal dripping is the most common reason for chronic cough, it is treated first with antihistamines, decongestants, avoiding any enviromental allergens.This cough tends to worse when the child is taking a nap or at night and begins soon aften laying down.If a trial period passes and he is still having symptoms then you would move on to the next step.
Asthma ,as you know, typically presents with a dry cough that is worse at night. If with treatment for postnasal drip , symptoms are still present and fitting the profile of an asthmatic (his chances are high since both of you have a history of asthma) then your doctor may prescribe an preventative inhalor for him. These inhalors are steroid inhalors however there is minimal absorption into the system and the benefits of their use outway any side effects. The most common side effect would be oral thrush. (In light of the family history of asthma, you may want to do this stage first and start him with an inhalor steroid).
If treatment for the above 2 fail then, you would move on to treatment for gastroesopahageal reflux which is also responsible for constant coughing.

Another possibility is repeated infections, because at his age , he can have up to 10 colds a year, it is possible to have repeated infections that give the impression of a chronic cough.

I know it can be difficult hearing your child cough constantly, my 3 yr old had a constant cough for about 2 mths and it turned out to be reflux.
Your doctor will take a through history and examine your son to determine which is the most likely contributor to his symptoms.

I hope this helps , feel free to ask any other questions
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