Can anyone help? Cough variant asthma in toddler?

[Reesewithafork]

DS 2.5 years has had a chronic cough since February. He got Covid but didn’t have a cough then the cough started after he had recovered. He started nursery in April and has had the back to back infections since then, cough always comes with it. It gets a bit better after antibiotics but always lingers and then comes back.

it does seem to link with the pollen count being high, although when we went to the coast the cough wasn’t much better.

He’s recently recovered from another upper respiratory infection, another course of antibiotics and was given ventolin for the cough. This seemed to really help and the cough was almost gone. The last three or four days though it’s come back again. Sounds very mucousy, comes in fits, worse when he’s laying down. I know the pollen count is really high here, could that really be it?

I’ve given him his inhaler but it doesn’t seem to have made a massive difference to when he’s sleeping, or trying to sleep. I think he improves with it during the day though.

Piriton alone doesn’t do anything. A humidifier at night does seem to help and I’ve propped up the mattress.

im just at a loss as what to do next for him. He never seems to be able to shift it and whenever I take him to the doctors they just say his chest is clear.

im wondering whether it is in fact cough variant asthma and he needs a brown inhaler. Does anyone have any experience of this?

Yes, it could be asthma. My youngest DC has coughing as her main asthma symptom. She’d cough all night every night. Any time she caught a cold…it would come with a cough. The coughing at night we figured out was due to a dust mite allergy. So had to purge her bed of all stuffed toys, and regularly wash sheets/bedding on hot, hoover mattress, remove carpet from bedroom, dust weekly etc. Might be similar for your DC if it’s coughing at night?

I’ve been diagnosed as an adult with cough variant asthma after struggling terribly with it. Coughs after every cold, it was so bad it would last weeks and prevent any sleep and be really painful. It’s awful because like your child, I’d get dismissed as my chest was clear.

I use a symbicort (powder) inhaler, it took a few weeks to take effect and you HAVE to keep using it, but it’s changed my life.

This sounds like protracted bronchitis. Any cough that lasts longer than four weeks should be investigated. Obviously hard at this age as they pick up new viruses regularly.
It is usually diagnosed by a cough that lasts longer than four weeks, gets better after antibiotics for a small amount of time and then returns with a vengeance.
If there's no wheezing or shortness of breath, it is unlikely to be asthma. Asthma also wouldn't improve after antibiotics.

The treatment is a longer course of stronger antibiotics usually 2-3 weeks.
My son had a cough for two years. He was exactly as you described, the inhaler helped sometimes and we would get some improvement after a short course of antibiotics. It was constant. He was treated with three weeks of antibiotics and he has been cough free for over a year. Now when he gets a virus, the cough is gone in the normal amount of time. It's been life changing.

Sounds identical to my grandson. Take him back to gp for referral to asthma specialist. Do it as soon as you can. You may or may not need antibiotics for any secondary infection but insist on having asthma confirmed or not. Good luck.

If there's no wheezing or shortness of breath, it is unlikely to be asthma.
unless it’s the cough variant of asthma.

Asthma also wouldn't improve after antibiotics.
unless there is the very common scenario that a chest infection is triggering asthma, so the antibiotics treat the chest infection so things get a bit better but not all the way better as the asthma remains.

Yes, my daughter was exactly like this at 2 - she eventually (after many GP trips) got an asthma diagnosis and a brown inhaler. She still (at 7) gets extended coughs after colds but not the ones she was getting before where we'd have to sit her upright all night as she was scarily breathless.

@nameisnotimportant how did it get diagnosed? I’ve taken him to the doctor so many times, I’m at the end of my tether. The poor boy has had so many antibiotics in the last three months due to nursery infections as well :( it does sound exactly what he has though, gets a bit better but then comes back.

He doesn’t seem breathless but the coughing fits seem to be getting worse and he’s sometimes sick with them :(

the doctors just keep saying his chest is clear but it does not seem normal to me for it to persist this long

Suggest a referral to specialist as you have seen no improvement. Insist if you must. It's a variant of the usual asthma, not always recognised by GPs. I recognised it with grandson as I have it myself.

@Reesewithafork
The chest is often clear when listening with a stethoscope with protracted bronchitis. It is diagnosed by the symptoms of a persistent cough for longer than four weeks which historically has improved after a short course of antibiotics

@Discovereads
Asthma obviously can cause a chronic cough but asthma causes a chronic wet cough in approximately five per cent of cases (this is Australian data) but is usually associated with recurrent episodes of wheeze and shortness of breath.
Based on what you the OP has described, I personally think it's more likely to be protracted bronchitis than it is to be asthma.

Op you need to research this and present the information to your Gp and push for some sort of treatment. Don't just let them fob you off. I had to really stress how long my child had been coughing for. I took in phone recordings of the cough at night time when my child was 'well'. I kept a diary of the cough and what illnesses my child had had. I wrote down the dates of when we had anricbitoics and how long the cough improved for.
I stressed how much of an impact this was having on our daily lives, especially during covid when everyone looks at you like you've got the plague when your child counts.

I hope you find an answer, it's a pain in the arse!

Cough variant asthma is different to normal asthma, it isn’t linked to wheezing or shortness of breath.

Definitely see an asthma specialist otherwise GPs have a tendency to ignore you and say ‘it’s just a cough’ when there’s no obvious underlying symptoms.

*coughs 🙃

I managed to get DD diagnosed - I took her after DH had taken her several times and got the usual 'it's just a cough, go away' stuff, I took her and told GP that there was a strong family history of asthma (both DH and I), and she immediately said 'Oh, it's probably asthma then' and gave us the inhalers to try which immediately improved things and so she was diagnosed. DH had previously failed to mention the family history...mine in particular is cough variant and I was constantly being told I had bronchitis as a child (wasn't diagnosed until 11). So you could always claim a family history.

I’ve booked an appointment with the asthma nurse. Hopefully she can help, and if it doesn’t seem to be asthma then I’ll ask about protracted bronchitis. I’ve kept a note of when it gets better, when he has had antibiotics, when it gets worse etc so I can use that too

it’s so horrible and I feel so sad for him because the coughing fits really upset him at night

.mine in particular is cough variant and I was constantly being told I had bronchitis as a child (wasn't diagnosed until 11)

Mine too. Mine is cough variant with exercise as a trigger. I wasn’t diagnosed until 14 after collapsing during a sports run and needing an ambulance. Prior to then I was just told I was “unfit” and more exercise would “condition” me.

From the responses I’ve read so far - some are worrying - I suggest you actually try websites with advice written by doctors - here is one such uk site Asthma uk

I would urge everyone to read this tbh - my son does not wheeze he coughs. Uncontrollably when he has an asthma attack. Due to not listening nor reading his asthma card and the absolute ignorance of the first aider at school he was left in a corner for an hour on his own - they assumed covid. He ended up in hospital.

Personally op I would write a clear diary from birth of every episode you can’t think of snd ask the gp to review. Now if you have been given pumps you need to give them time / if my son has a cold from the very beginning of it I have to double the brown dose and put him on a minimum of 6 blue doses just to try and control. It took us a while to get it under control when he first went on pumps it was not an overnight solution. Best of luck - one thing is most outgrow it. Plus as the doctor said once under control exercise and good diet all helps.

@MrsPear thank you that’s really interesting. Your poor poor son, how frightening for him and you.
im very very vigilante in terms of it being possibly asthma and it’s why I want to get to the bottom of it asap. I’m hoping the asthma nurse is going to be helpful next week.
@MrsPear in terms of pumps we have a blue ventolin one - I kind of was expecting it to be a magic fix for the coughing but it sounds like we should give it a bit of time? We have been been using it only as the cough starts again but perhaps we should be giving the full dose daily at the moment to see if it combats the cough.

I’ll look at the website thank you. He was always a very spluttery reflux-y (we thought) baby who would have coughing fits even then

The other thing is - can asthma produce a wet sounding cough? I always thought it was a dry cough but thIs sounds productive even though he can spit mucuous out if you see what I mean.

Good luck. Once diagnosed, the combination of brown and blue inhalers worked wonderfully and the whole household managed to get back to having a full night's sleep again. He's just finished his GCSES today and has nearly outgrown the asthma.

Usually asthma is a dry cough, but a wet cough doesn’t mean it’s not asthma.

Here from Asthma UK
”Not everyone with asthma coughs. If you do cough it’s usually dry, or someone with uncontrolled asthma might have thick clear mucus when they cough.”
www.asthma.org.uk/advice/understanding-asthma/symptoms/

Yes my 4 yo daughter is the same. We have a brown inhaler and it's massively helped. She suffers when the weather changes but being consistent with the brown inhaler he's stopped the cough coming back bad the last few months.
We've got a course of steroids as well just incase as it does come back very quickly

@Reesewithafork
The wet cough that comes back after a short course of antibiotics in particular is what made me thinks it protracted bronchitis as asthma is 'usually' a dry cough. However, with constant viral infections the cough could be wetter.
Of course, he could also have asthma as well on top of this, so I think you should push for a specialist referral or at least try an speak to a different Gp. Good luck op

Another vote for cough variant asthma. I'm so bloody cross my dc had to struggle for so long, constant cough, affected sleep/sport/school life. It was a random meeting when we were abroad a lovely woman came up to me when we were in the pool and said she was worried about my dc and she thought it was cough variant asthma. This gave me the courage to fight when we returned.

My son also coughs badly at night- he was on the blue inhaler but after persisting when the GP they have prescribed him a brown inhaler to take morning and night, and this seems to have helped. Also, I have started leaving his bedroom door open for the air to circulate and this has helped loads.