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Cough, fever, antibiotics, chest infection, Prednisone, Ventolin, no tobacco smoke

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Practicing since : 1991
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Hi, my 4 year old son (DOB 3/14/07) has had a recurring cough about 5-7 times in the last year. It always starts off with a fever (seems to be only at night), cough that gets worse and worse as the days go by, and finally a visit to doctor who prescribes antibiotics for chest infection, a steroid (prednisone) and either inhaler (mask) or inhaler in the form of ventalin syrup. The antibiotics seem to work each time, and when I let the cough go to see if it will just go away on its own (as I am worried about giving too much antibiotic), it always gets worse to the point where he is visibly sick, tired, achy, congested etc...I have noticed that swimming in the pool triggers his cough. he has no exposure to tobacco smoke, and we live in the Caribbean. what could this be? what kind of doctor should i take him to? he doesn't seem to have any other health issues. his height is about 41" and he weighs 37lbs
Posted Tue, 1 May 2012 in Asthma and Allergy
Answered by Dr. Sumit Bhatti 2 hours later

Thank you for your query.

1. Get an X-ray skull lateral view to rule out Adenoid hypertrophy. This normally occurs between the ages of 3 and 7.

2. Chronic nasal obstruction gives rise to post nasal drip which causes cough and other symptoms mentioned by you.

3. Does he snore or have mouth breathing at night? Remember that this partial nasal obstruction fluctuates. Get an ENT Specialist's opinion.

4. In the light of the above mentioned symptoms, it is also recommended to consult a chest physician, especially with evening onset of fever and also if he develops a wheeze while breathing.

5. Some children also have Laryngo Pharyngeal Acid Reflux (LPR), which can give rise to all these symptoms and must be ruled out.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

Above answer was peer-reviewed by
Follow-up: Cough, fever, antibiotics, chest infection, Prednisone, Ventolin, no tobacco smoke 1 hour later
I read the symptoms and definitions of Adenoid hypertrophy, chronic nasal obstruction, and LPR. and none of these possibilities seem to be relevant. His cough is productive, and recurrent, but not chronic. He does not snore, and does not seem to have any trouble breathing. He does present some wheezing while the cough is present, but not when the cough is not present.

he has had 2 chest xrays to look for infection and/or some reason for recurring bronchial infection and both times the doctor said it looked normal (2 different doctors)

my question is should I continue to give him the antibiotics (since this is the answer I get from all doctors he has seen for the cough)? it seems to work, meaning the cough and fever etc go away, but it seems super unlikely that he has had more than 5 infections requiring antibiotics in one year?

is there any validity to the fact that we observe that swimming triggers the cough?
Answered by Dr. Sumit Bhatti 8 hours later

1. It is better to confirm the adenoid status with an x-ray.

2. Get a sputum examination and culture and antibiotic sensitivity for three consecutive days if he has productive cough. Check for bacterial, fungal infections and tuberculosis.

3. Get a Spirometry or Pulmonary Function Test (PFT) done. This will help differentiate between an upper and lower airway problem.

4. Let him have a full course of antibiotics based on the above.

5. Cough after swimming is probably related to exposure to chlorine or it's byproducts, Exercise induced bronchospasm / asthma or silent LPR.

6. Try not to brush aside any probable diagnosis. While most people think about one disease at a time, problems are usually multi factorial. Pursue each suggestion systematically.

Above answer was peer-reviewed by
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