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Child having cough, have junior asthma, not cured by steroid inhaler, worse appetite at night. Treatment?

My son who is 15 months keeps getting coughs that are really bad every 2 weeks. The doctors said it is junior asthma but even with the steroid inhaler there is no change and every couple of weeks it returns. his appetite remains (which is very healthy as he us a big boy) in the day he struggles and it is worse at night. I do not think it is asthma and I am worried please help. Regards Richard Smith
Asked On : Fri, 8 Jun 2012
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Allergist and Immunologist 's  Response
Dear Mr Smith,
Reading your query it seems that your 15-month-old son is having upper airway problems both during the day and night, but worse at night, and you do not think the steroid inhaler has helped.

Nocturnal cough has many causes, such as gastroesophageal reflux disease (i.e., hyperacidity) that respond to acid lowering agents (such as Gaviscon (UK), or proton pump inhibitors (omeprazole etc); and then 'junior asthma' that responds to as required salbutamol inhaler (but you need steroid inhalers as rightly prescribed if that happens during the day as well); and of course, allergies that need excluding. Asthma in little children is difficult to diagnose particularly as they are unable to perform lung function testing, so trial of bronchodilators or the leukotriene inhibitor (see below) is the usual management plan.

If he has wheeze during the day when he is playing (i.e., exercise-induced asthma), a trial of montelukast can be recommended.
If there is history of eczema and family history of allergies, skin testing (or specific IgE blood tests) is important to exclude common household allergens such as house dust mite, cockroach etc and specific treatment (including avoidance strategies) can then recommended.

I hope this is useful.
Best Wishes.
Answered: Sat, 9 Jun 2012
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