Can anyone talk to me about cough-variant asthma?

[MrsKCastle]

I'm a bit lost with what happens next with my 11 year old DD. She has been prescribed a salbutamol inhaler due to a persistent cough which lasted many weeks, was worse at night and triggered by exercise, especially swimming.

She has been taking 1 puff morning and night and 2 puffs before exercise or when coughing. It seems to have helped, but it's hard to tell for sure if it's the inhaler or just the cough finally fading away. She is still coughing but not so much.

My question is, how can we tell the difference? The GP who prescribed the pump wasn't very clear about what happens next. He said she might need a preventative inhaler, but how will we know if/when to go back? Should we see an asthma nurse? It's all confusing!

My son has cough-variant asthma, diagnosed 10 years ago, at the age of 5. A night time cough was his only symptom at the time and even now an ‘asthma attack’ for him is just coughing and coughing so hard that he vomits. He’s never had a wheeze. We were told at the time that if the brown, preventer, inhaler stopped the symptoms then it would be assumed he had asthma. It has been well controlled for years, only needing the meds adjusted after growth spurts and during hay fever season.

I would go back if it still hasn’t gone. And definitely see the asthma nurse, they tend to be better informed than the GPs.

So you’ve just been given a blue inhaler, not a brown one? That seems odd.

Yes, just the blue one. The GP seemed to be saying that if it didn't work fully we should go back and look at possibly getting a brown one. He wasn't very clear though,hence me asking here! As I say, she is seeming better but not completely right e.g. three week ago, before getting the inhaler, she couldn't swim a length without stopping halfway for a fairly long coughing fit. Today, she took 2 puffs beforehand and coughed several times but single coughs, and not so exhausted after the lesson.

I would make an appt to see the asthma nurse. When my adult onset asthma was getting diagnosed i was told that if the blue inhaler helped then it was asthma.
Asthma doesn't have a straightforward set of diagnostic criteria and cough variant asthma is harder to disgnose.
I think asthma uk have a telephone number where you can call and speak to an asthma nurse.

Thank you Weatherwaxed. I've just had a look at the Asthma UK website and it's very informative. Seems as though it might take a while to get a clear answer as to whether or not she has asthma though.

I have cva, definitely make an appointment with an asthma nurse and make up an asthma plan. You can get blank ones from the asthmaUK website.
Also they always issue the blue inhaler with a standard dosage but if she is bad then she should use it more. On a bad day I take about 10 puffs a day. On the other hand I usually don’t take it at all for weeks at a time.

Sounds like she needs a preventer if the blue inhaler gives relief. Chlorine is a trigger for many, your dd should have her inhaler at the side of the pool.

I use a humidifier at night when my cough is bad which helps a lot.

Thank you everybody. Books, yes, it does seem as though chlorine is a trigger for her. I'm glad you said that because I haven't seen that mentioned on the Asthma UK site, but it is one of the main things we have noticed.

Unfortunately, she is quite embarrassed about the pump. She was diagnosed with coeliac disease less than 6 months ago, so dealing with that and then this is getting her down a bit, and as a new Y7 she doesn't want to appear 'different' from her friends in any way.

I will try to get an asthma nurse appointment though. Would they be able to do peak flow and other tests, or at least refer her?

The asthma nurse can do peak flow tests. As others have said, she should have a preventer to take twice a day, not a reliever.

She shouldn't need a referral, it should be quite straightforward for the asthma nurse to deal with although with medication it can take a little trial and error to find the right ones. They really know their stuff, far more than the GPs in my experience. I was only referred when my asthma got to the point where I was at the limit of what could be prescribed medication wise by the GP surgery, and was then diagnosed with another condition where the medication can exacerbate asthma symptoms, in case I needed other medications that couldn't be prescribed at a practice level

Dd has this and to start with was only given a blue inhaler by the gp. This didn't help and I requested an appointment with the asthma nurse. We did two weeks of peak flow tests and now dd has a preventative inhaler as well and the cough is more under control, only flaring when dd is ill.

Definitely go and see the asthma nurse.

Definitely make an appointment to see the asthma nurse. If taking the inhaler when she’s coughing helps, and the coughing has reduced generally but is still going on, you might find a preventer makes all the difference.

Telling the difference between cough & asthma cough isn’t an exact science. I still get it wrong sometimes. I think that if you can get it properly under control with a preventer and she’s breathing more freely, she might start to notice other smaller symptoms that go with the cough. If it hasn’t been under control for a while some of those things might seem ‘normal’ at the moment.

I'm always on alert when my dd gets a cough as twice in past she's been hospitalised with breathing issues after long on going cough.
When she's coughing alot we give her blue inhaler via volumiser... Is this possibly the type of asthma being described as in all visits to hospital or docs I've never heard of this?

I’m another person surprised you only got salbutamol. That only helps during an episode but it is not helping the issue in the short, medium or long term. Please go back and ask them to explain why your kid has not got a preventer inhaler.

DS and I both have this. DS was diagnosed at 3 years old.

Agree - asthma nurse, and see if they will prescribe a brown inhaler. I'm now on a long term reliever as well, but ds manages fine with the brown.

His triggers are cold air, and swimming pools, but I've found that a dose of anti histamine before he goes swimming deals with that fine.

As a toddler , he would cough until he was sick. He's got better as he got older, but had one dose of steroids when he was in year 5, as he had a more serious episode.

I'm far worse than him, but a lot of it is because it wasn't managed when I was younger, and now I'm probe to upper respiratory infections.

I’m another person surprised you only got salbutamol.

I think this is standard for diagnosis. I was coughing during exercise among other things and the doctor gave me salbutamol to try before exercising - if it prevented me from coughing then it was clear sign I had asthma (and not something else). When I went back in for another appointment and confirmed that the salbutamol worked, then he formally diagnosed with asthma and prescribed a preventer.

I would think it’s pointless to prescribe a preventer without knowing if the salbutamol works first

Yes, PaperFlowers, I think that was the reasoning - see if the salbutamol works and then decide on the next steps. As I say, it does seem to be helping somewhat, so it makes sense to talk to an asthma nurse.

Rafals, it's interesting what you say about other smaller symptoms possibly being overlooked. DD never complains of a tight chest or anything like that, but she is constantly tired and lacking energy. With the coeliac as well though, it's hard to know what is going on.

I was only prescribed salbutamol at the start too.

Tiredness & lethargy could definitely be linked to the asthma. The tight chest is interesting though. If it’s ‘normal’ for her she might not complain unless it’s really bad because she doesn’t see it as different.

Yes, I didn't realise that my chest was tight until I got the asthma under control. It was normal for me.

Okay, if it worked then go back to the GP and get the other one ASAP. The blue is only for emergencies, the other ones are the ones that make the issue better.

Thanks again for all your advice. MN is excellent for this kind of thing. I'll get another appointment for her.