Cough variant asthma. Is there a test for it? Differential diagnosis? Is DD being fobbed off.

[bookmarket]

DD was diagnosed with cough variant asthma around age 12. She's now 17. Inhalers don't seem to do anything and she's been on various. She finally made an appointment to see the nurse to ask 'is it really asthma?' Nurse gave her peak flow chart to track a month. She said she'd refer her if peak flow okay. Tracking proves peak flow does not dip, even when she's having a coughing attack. The nurse then mentions trying another inhaler and mentions montelukast again - which were not happy with her trying. She agrees it might not be asthma and will speak to the GP. DD then gets an appointment through - with the other asthma nurse!

I don't know how pushy to be here. I feel she's being fobbed off. She didn't want to be on medication (inhalers) that do not help. How likely is a differential diagnosis? Is there testing that can be done to rule out/confirm asthma? Does she have any hope of being referred if she refuses to try montelukast which is clearly part of the pathway of things to try with each patient. Going to see the asthma nurse again seems pointless as all they can do is follow that pathway.

What would they look for on an x-ray? Dunno, anything untoward, I guess. She's not had it yet, as her new inhaler has improved things, so she will have the x-ray next time she gets the cough back again.

I've had cough varient asthma for 25 years.
My peak flow never changes and I don't have asthma "attacks" just cough.
It's very much triggered by allergies but anti histamine alone doesn't stop it.
Is your DD actually on a steroid inhaler or does she just have ventolin?
Steroid inhaler controls mine well. If I get a virus or exposed to dust it gets worse and a temporary increase in my steroid inhaler sorts it out.

I tried montelukast. It did help dramatically but I didn't like the side effects, mainly palpitations.

@Mosik She has a combined steroid inhaler.

Which inhaler works for you?

I have cough variant asthma, diagnosed in my 20s but looking back I obviously had it as a child.

Montelukast is a wonder drug - and I have anxiety and panic attacks.

Daily antihistamine is also a game changer. They don't prescribe them anymore but you can buy a year's worth of cetirizine online for not much. I also won't allow any fragranced products in the house

When you are short of breath all the time you don't know what normal is, and can't pinpoint any allergies. My mind was blown the first time I wasn't short of breath.

Asthma UK is a great source of support and information.

I am never short of breathe. Just cough, cough cough.
@bookmarket I take a combined inhaler - seretide.

OP, I thought my don had asthma for years but, like your dd, inhalers didn't help. Eventually I kept a diary and noticed that his cough seemed to start shortly after eating or drinking (he was regularly snacking, so this connection wasn't as obvious as you might think). When I mentioned this to the GP, they referred us to a specialist for barium swallow imaging. It turned out that he had a slight "delayed swallow" which meant that food was regularly going into his airway then being ejected - so he didn't choke, but his airway was getting slightly irritated, causing the cough.

Now that he knows what it is, he is able to eat more slowly and carefully, and the cough is less regular.

Yes that’s what was prescribed privately and worked for us, after the 2 things the GP prescribed didn’t

Thanks everyone. She's now been referred to ENT and given a nasal steroid to try instead of her combined steroid inhaler.

Sorry I totally missed this - I take Fexofenadine Hydrochloride 180mg which is higher strength than the OTC stuff which has in and of itself only become available OTC in the last 2 (ish) months.