asthma cough -- any suggestions?

[theabysswithin]

DD who is 6 has asthma -- its reasonably well controlled most of the time with the brown ICS inhaler and salbutamol if needed, but she tends to have two or three bad spells a year, almost always triggered by a viral infection (not all viral infections trigger but when they do it can take two weeks or so for her to fully recover).

She doesn't tend to wheeze or get breathless unless things are really bad and generally at that point she's on her way to the GP/A&E. The problem is the chronic cough which can literally be constant - every 10 or so seconds almost around the clock -- for anything from a week up to two weeks after a bad attack. Cystic fibrosis and other potentially scarier things have been ruled out.

Sometimes salbutamol works for the cough, sometimes it doesn't. I have tried literally every other conceivable suggestion in the book: steam, Vicks, raised pillows at night, warm water to sip, cough medicine, honey, you name it. There is nothing that makes any impact on the cough. Its horrific, mainly for DD, for obvious reasons, but also for me because it means I get horrendous levels of sleep deprivation and get to the point where its hard to function at work etc. Apart from this I also worry about the impact on her lungs and respiratory system of the spells of constant coughing. Doctors are monitoring the asthma and its a fairly rare occurrence but when it happens its just appalling.

Does anyone know of anything which can be administered in an acute situation which will deal with the cough? I am not talking about a general day to day cough but the kind of constant asthma-related cough which goes on for weeks? Is there anything - and I'm talking pharmaceuticals here, as natural remedies etc don't touch the sides - other than oral steroids and nebulisers, which can be given to alleviate this?

@theabysswithin I think it's because each child is different but I've had two friends now whose children have viral wheezes in and out of hospital and I've pushed them to ask for preventors

Lo and behold when they start the preventors they've had no exacerbations. I would suggest your preventor dose needs upping or looking at another preventor

back to gp/asthma nurse for asthma review.
tell them what you have in your opening post.
your dd might need a different preventer. I would also suggest physio once this cough is gone.

Can I ask what the cough is like? Is it a dry, throat clearing one?

If so, its likely to be a result of post nasal drip so if you get on top of this with a nasal spray then the cough will disappear.

I found Asthma UK exceptionally helpful. They have asthma nurses who will talk you through everything. It was a game changer for us.

Best wishes to you both. Its so tough.

An asthma cough needs urgent medical attention

I was told this by consultant asthma doctor . My ds suffers asthma and I was told an asthmatic cough is a sign asthma is not controlled and needs urgent medical attention

I always doubled the brown inhaler when they got a cold. Then tailed it off again.

In terms of managing it while you wait for it to resolve, ice lollies were our best solution. The cold numbs the throats and reduces the irritation.

As others have said, your DD's asthma is not controlled. She really needs to see someone other than your GP.

How do the hospital handle it when she leaves? We were always seen by asthma specialists at the hospital after discharge.

Montelukast is definitely worth trying as are anti-histimines and different inhalers. A pp also suggested nasal drip, which I've had and does cause a horrendous persistent cough after illness.

You have my sympathies, we had this with DS nightly from October to April pretty much every year.
What helped us, well main thing was he grew out of it, thankfully, also...
Losing weight
Steroid nasal spray
Antihistamine
No dust in room, anti allergy bedding
Air humidifier/purifier

Tried montelucast, was horrendous, made DS depressed & very unlike himself, night terrors as well.

Think he had post nasal drip which triggered the coughing, he also sounded like he was drowning while asleep. We spent weeks sleeping with him held upright in our arms, horrible times.
Hope you get it sorted.

Mumof41987 she has had urgent medical attention -- she has been to four A&Es in a week :)

Thanks again everyone. For those of you saying she needs to see someone other than her GP she is being seen by a consultant at a major hospital who has been monitoring this for nearly a year. They have run a battery of tests on her etc.

Unfortunately when she initially started seeing the consultant the symptoms were in abeyance she had a fairly long period (10 or so months) without any exacerbations or symptoms and they recommended we taper off the preventer which in retrospect was probably a mistake but I guess they have to try. We're back on it now with a vengeance. I think this is the difficulty for them in general terms on a day to day basis her asthma is well controlled in the sense that most viral infections now don't lead to exacerbations.

When I've mentioned that I don't think the asthma is well controlled they point to the fact that in general terms she's in good health, no cough and wheeze and asymptomatic. The problem is these rare, but serious, episodes.

I've asked about moving up to montelukast and the green inhaler (Axovant?) and they have tended to say that these aren't really appropriate for cough variant asthma. But in the light of this I think I will go back to the drawing board.

If she is suddenly worse you may need to look at allergic asthma from hayfever being a trigger at a specific point in the pollen calendar and using antihistamines as a potential treatment?

Is the hospital she goes to for A&E liaising with the one her consultant is at? Or are they the same one anyway? If they can send records of visits each time they'll get an idea of frequency and treatments. Something like seretide or similar combination inhaler might be good - mix of the stuff that's in the brown inhaler and a long acting version of the blue inhaler. That's usually the next step up from a brown inhaler (I think).

handmademitlove she's been tested for about a dozen common allergens: pets/pollens and dust related and come back negative for all.
DottyGiraffe the most recent of the A&Es is the same one where she's been seen, yes. I've heard about Seretide and might raise this with the consultant when I go in next.

I don't know which combi inhalers are the best, and of course different people will find different drug combinations work better, but sounds like a combi inhaler might be better than just the brown one. And/or montelukast (that used to be a step up from combi inhalers but some people say their child has montelukast alongside brown inhaler so maybe it depends - probably what a particular dr feels like at the time!)

Hi OP sorry I'm exhausted so can't read the whole thread but both my kids have asthma which manifests as a cough - tbh I think it's fairly badly understood. E.g. I've had HCPs tell me it can't be asthma because there's no wheeze.

Both my kids (6&10) are now on the purple inhaler morning and night - seretide 50mg- 2 puffs each time and it's made a huge difference. They also have regular cetirizine - ds only in summer but Dd all year round.

Ds is also on montekulast but only recently and it has helped but he didn't need it at all until he unfortunately caught whooping cough.

I second (third) seretide - I have been prescribed it when usual preventer isn't enough and it really settles my wheezing and cough down.
I had to stop eating dairy for a year while bf my dairy intolerant ds - I found it made a huge difference to my asthma symptoms and when I went back to eating it again I did feel worse. More coughing and my chest felt 'heavier' and more mucusy. I had none of the usual signs of dairy intolerance and still don't. I eat dairy now but tend to cut it right back if I have a cold and it does help. I'm not suggesting for a moment that you use it instead but it might be worth a try in addition to medication.

Haudyerwheesht yes I've had this comment as well from several doctors -- I've actually been told by A&E departments that she shouldn't be there because she's "only coughing and there's no sign of respiratory distress". Generally I'm quite shocked at the poor levels of understanding around asthma generally. There seems to be very low recognition of the fact that its a potentially fatal disease.

Seretide is an interesting idea as well -- have been told about this in the past. Will mention all this when we next see the consultant.

My dad has allergic asthma due to dust and pollen. Initially diagnosed as a dust mite allergy, he was given an antihistamine and blue inhaler . He had a constant cough. Changed his bedding, dust mite covers etc but then he would up in a and e after bad coughing episode.

Put on Montelukast, which helped but the steroid nasal spray.has really knocked the post nasal drip cough in the head. He doesn't get any wheezing so inhaler not really helping cough. Steroid nasal spray did the trick. Respiratory clinic appt coming up.

Not Dad! My dear son! Aged 7

Seretide has changed DS's life. The GP was reluctant because of cost I think but a paediatrician friend told me to insist so I did and it's been an awesome improvement.

Have you been to the doctors? You shouldnt use cough medicine to suppress an asthma cough unless a doctor tells you too. Is it tickly or chesty?