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Dr. Andrew Rynne

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Child's cough not responding to rescue inhalers. X-ray showed hyperinflation and bilateral cuffing. Worrisome

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Dr. Shashi Dangwal

Pulmonologist

Practicing since :1979

Answered : 1126 Questions

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Posted on Thu, 7 Feb 2013 in Lung and Chest disorders
Question: is is normal for a rescue inhaler to NOT stop a cough if a child is suppose to have asthma....one ped told me my child has asthma and another ped told me that my child does not have asthma, because he had a very bad cough and it would not stop, even after the inhalers, steroids and 3 doses of the "mask" they give you in the ER. It is possible for a child with asthma to still have a cough after all this. His xray shows hyperinflation and bilateral cuffing I believe. He has a cough more than he doesn't have a cough. He also has a blue vein and it goes down his cheek that appeared around the same time all the asthma started. He takes his inhaler twice a day, plus he has a rescue inhaler that never stops his cough but i am told to keep giving him the rescue inhaler as needed.
His chest is usually always clear according to any doctor, except if he has a chest infection or something. He doesn't wheeze except for a few times last year he was sick during the night and couldn't breath right and the doctor said maybe it was croup and he had his adnoids out after that. At that time he had been coughing for months!! After the surgery, he was on athrithomax and his cough just went away while on it the arithomax. Not sure if this is related. A few months ago he was coughing hard again for weeks. That was when another ped said it was a viral infection and that he doesn't have asthma. Now he is coughing again after having a cold or something and I am afraid it will go on and on again.
also, a few months before all this started my son had a coin caught on top of his voice box..and they removed it with bronchoscopy.
the only test he had since the asthma started was the xray and cbc.
doctor
Answered by Dr. Shashi Dangwal 17 hours later
Hi XXXXXXX,

Thanks for posting your query on XXXXXXX

yes-your child`s cough can still be asthma despite not responding to rescue inhalers and it is because of inadequate dosage which is not able to overcome the spasm of the airways or control the inflammation.

It`s not easy to make a diagnosis of asthma in children because they are unable to perform spirometry(test used to make diagnosis of asthma). The diagnosis is generally based on clinical symptoms and doctor`s judgement. In children, once infection has been ruled out, persistent cough can be because of asthma or a condition called hypereactive airways syndrome.

If he is not responding to rescue medication, you may have to start him on preventer inhaler as well. Try out seroflo100 or foracort100 2 puffs twice a day. Give these inhalers through a spacer device so that XXXXXXX medicine enters the lung and not wasted. Make him rinse his mouth thoroughly after using inhalers. Give him a tablet of montair lc kid at night. Continue using rescue inhalers(asthalin or levolin) on SOS basis. I`m sure he will respond to these measure. Protect him from extreme cold and cold and dry air, smoke and dust.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shashi Dangwal 10 minutes later
He is taking preventive inhalers already for almost a year....alvesco twice a day. If his cough didn't respond to that...plus the rescue inhaler..plus 3 days of oral steroids...plus rescue inhaler before going to er....then the mask 3 times...is that common....? Could that mean he has really bad asthma or something else? Do u think he needs a bronscopy.
doctor
Answered by Dr. Shashi Dangwal 1 hour later
Hello XXXXXXX,

Your child has been on alvesco and as per your description he is still symptomatic. Having gone through your description, i feel that his symptoms were quite under control and only recently he has had an exacerbation which is a common occurence in children with asthma or hypereactive airways syndrome.

You may change his inhalers to seroflo100 or foracort100 as already suggested by me as sometimes taking same medicine over a long period of time, one may develop tolerence to it. The mode of drug delivery is equally important as maximum medicine should be inhaled, hence advisable to take through inhalers through spacer. You may increase the frequency to 3 times a day if symptoms persist. All these measure may sound trivial but go a long way in proper control of asthma symptoms. Montair lc kid is also a good drug to control inflammation. If symptoms are more severe another course of oral steroids for at least 5 to 7 days may be required. Avoidance of exposure to allergens is also important.

His chest x XXXXXXX is suggestive of air trapping which is a feature of asthma. In my opinion bronchoscopy is not indicated at present. If you are very concerned, you may get a CT chest done though in my opinion, even that is not warranted at present as your child may outgrow the asthma as he grows.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shashi Dangwal 5 hours later
Thanks for your answer. Could the xray results mean anything else? Could it mean he just had reactive airways at the time of xray? Is it common to see those results in normal children that are just coughing at the time of xray?

Also, I was wondering if any type of foriegn body aspiration could mimic this type of asthma and if "signs" of foriegn body aspiration could escape detection on a chest xray? his chest is clear with a stethoscope when he isn't sick and his chest is also clear when he is coughing...except for a few times when he was really sick. his cough is really hard though and last forever. The first time it lasted about 5 and 1/2 months!!...(started inhalers after 3 months but continued coughing the whole 5 and 1/2) and then after 5 and 1/2 months it just disappeared while he happened to be taking arithomax for something unrelated (post adnoids surgery) Then the cough went away for 4 months. A cough came back again for 2 months. Went away for 3 months. Now back again so far about 8 days and not getting any better. Just very worried about all this coughing and I want to make sure that the doctors aren't missing anything.
correction..the time he started inhalers was maybe closer to 3.5 or 4 months after the coughing started, not 3 months after coughing...
doctor
Answered by Dr. Shashi Dangwal 18 hours later
Hello XXXXXXX,

Your child`s chest xray is suggestive of air trapping. In FB inhalation-hyperinflation will be only on one side where the FB gets lodged and over a period of time other signs also come up.

With FB inhalation, there is an acute episode of choking and then it becomes more chronic as the FB passes down to more distant and smaller airways. A FB may lead to repeated chest infection. Do you remember any such episode? Has the child always been prone to repeated chest congestion or he has always been healthy and bouts of coughing started suddenly.There are signs on chest x XXXXXXX which may suggest a FB inhalation but yes the detection can be missed. That`s the reason i suggested a CT scan of chest to rule out any other cause.

I suggest if you remember any episode of child suddenly having a choking spell, you go back to your pulmonologist and discuss it with him. In that case both a CT and a Bronchoscopy will be required.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shashi Dangwal 25 hours later
Thank you... the doctors told me that I would see something on on an X-ray if there was a fb...some sign of it. I don't ever remember and choking episodes...just coughing come on and the doctors always say they just have a cough....is a choking episode so different that it would stand out from a cough. Would it cough come and go?
I ask for bronscopy many times and they always say its not nessasary. I don't know what to do.
doctor
Answered by Dr. Shashi Dangwal 20 hours later
Hello XXXXXXX,

I totally agree with your doctors that your child does not appear to have a FB in his airways. All that advice was because you raised a doubt thus asked you about history of choking. Yes a choking episode is different than cough. Here, a person struggles to get a breath. I`m of the opinion that you should not get into all these details as you will get more and more confused.

I had already mentioned in my answer to your first query, that you son requires neither bronchoscopy nor CT Scan. So just relax and as i have said that your son will get over these couging spells/asthma as he grows.

Bye.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shashi Dangwal 28 hours later
Can runny nose give you a non stop cough? Right now his nose is runny and he coughs really hard upon wakening..nonstop for a long time......is the blue inhaler OK to give if the cough is from runny nose? And if yes..would it stop that kind of cough
doctor
Answered by Dr. Shashi Dangwal 20 hours later
Yes a runny nose can give a cough because while sleeping secretions from the nose dribble into the throat. This is called POSTNASAL DRIP WHICH IS A VERY COMMON CAUSE OF PERSISTENT COUGH. yES THE BLUE INHALER CAN STOP IT IF THE RUNNY NOSE IS Allergic in nature. Consult his paediatricin who can prescribe an anti allergic cough syrup which can be of help.

Bye.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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