At the end of my tether with DD's (20m) persistent cough!!

[HammerHorror]

DD, 20 months, has had a cough for over a year. It's mainly at night and it's most nights. Sometimes it's productive, sometimes it's dry.

I've been to the GP about this cough more than 10 times.

Earlier this year she was referred for a chest x-ray which showed inflammation in her upper respiratory tract.

She had another chest x-ray when she was admitted to hospital for pneumonia and had a shadow.

The GPs keep saying "she's picking up viruses at nursery".

She's been prescribed a ventolin/salbutamol inhaler but I don't think it makes much/any difference.

It's really concerning me but I don't feel listened to. Her nursery have expressed concern as she often feels crackly/crepitus in her chest.

She was a full term baby, no one in our household or extended family smoke, we live in a semi-rural low pollution area, the house isn't damp, she's thriving and developing well... I'm just so worried about this cough!

Any advice? Anyone experienced similar?

When you say the salbutamol doesn't work, has that been on a decent amount of puffs? Or have you only been let give a couple of puffs?

GP said to give her 2 puffs.

Are you using the inhaler with a spacer?

What dose is it? My almost 4 year old has a steroid inhaler for daily use and has salbutamol for use when he has symptoms but he can have up to 16 puffs a day. If he is bad I give 2 puffs every 15 mins for an hour as advised by hospital.
Are you going to the same GP all the time?
I would switch - my DS has been on these inhalers since being hospitalised at about the same age as your DD is now.
He takes montelukast now as well.
I think you need a new GP to be honest or an asthma specialist?

DS (6) has what we think is asthma but manifests as a winter cough. He is on ventolin which is a short acting beta agonist but also seretide which is a longer acting beta agonist plus a steroid. He also takes Montelukast.
I think you need to see the asthma nurse. They won’t diagnose true asthma so young but will treat his reactive airways anyway.

Allergies perhaps? Could you try giving a dose of piriton one morning and see if it makes a difference?
And correct spacer technique, shake before, breathe in and out 10 times per puff

My daughter suffered with an awful cough, about 6 months, after having croup. It got to the point where all the family were being affected. Took her to GP countless times inhalers didn't seem to work and chest x ray was clear.
I then tried a cool steam humidifyer which was also an air purifier and after about a week the cough was gone.
Good luck.

Has your GP ever suggested testing for cystic fibrosis?

The inhaler has a spacer.

I've seen various GPs and have even changed practices (due to a house move). The last GP didn't want to prescribe a steroid inhaler and there was something about montelukast having dairy and she had a dairy allergy.

All of them have said she's too young to diagnose asthma so won't refer.

We've also tried humidifiers.

I think I need to explicitly request a referral to the asthma clinic... they just seem to be really against referring her.

Have you asked for a referral for her?

DD (now I’m her 30s) had a nighttime cough after any cold no matter how minor. She would cough till she was sick and then it would settle for an hour or two and then start up again. It was a nightmare as she was exhausted and sickly.

Looking back I think she had cough variant asthma but that wasn’t known about back then. She was given a steroid inhaler which helped somewhat. She gradually grew out of it around 7 but until then it was dismissed by GP.

I would tell your GP your concerned about her cough and ask for a referral.

I haven't explicitly asked. I keep expressing how concerned I am.

DD has coughed herself to sickness on many occasions too.

She's currently been prescribed gaviscon again to see if the cough is reflux due to her CMPA ... but her dairy allergy is very well controlled so I don't think she's got reflux anymore.

Her chest x-rays haven't been clear. They show inflammation... why isn't that a concern???

I think you need an asthma referral too.

Oh crikey... so this requires assertiveness! Can I just go to the GP and say that I would really like a referral to the asthma clinic or respiratory medicine or something????

I think you’re right to be concerned and want to see an asthma specialist.

Just wondered whether her sleeping position is flat and if you’ve tried raising her mattress at one end? If she has mucus running down the back of her throat that could also make the cough worse at night.

Gaviscon did bugger all for my cmpa baby. He ended up on ranitidine and then omeprazole. Not saying that's the case here but it might be worth trying.

She has CMPA and had awful reflux as a baby so she's always had her cot raised at one end.

She went into a toddler bed a couple of months ago and it's raised at one end plus a pillow.

I feel like we've tried everything for her.. I really am at the end of my tether.

She was on omeprazole when she was a baby but her CMPA is under control now. She doesn't get any of the symptoms she did pre-diagnosis. I really don't think it's reflux... her breath used to have a certain smell when she had reflux.

My ds coughed and coughed and coughed as an older baby/toddler (started at 6 months). We were forward and backward to the GP, tried short course of antibiotics, inhalers etc until he had a chest x ray that showed he had collapsed part of his lung because there was so much gunk in there, and had infection behind it.
It took 3 months of antibiotics, chest physio and regular inhalers to clear the initial issue, and then he had to have medication to thin his secretions every winter till he was about 6 and it got better.

My son has this. It drives me potty wakes me up at 5am. He now takes montelukast which controls it well. He has a dairy allergy (not anaphylactic but causes itchy patches on his skin over time) and he has seen the allergy clinic and dairy was never mentioned in relation to montelukast...
My son was prescribed a steroid inhaler first and he had horrendous side effects - anxiety, depression, struggling to concentrate, struggling to sleep so they switched him to montelukast.

It sounds very like what DD had. She had bad reflux as a baby but I always felt the cough was nothing to do with that as it usually came shortly she started with a cold or tonsillitis. And it would go on for about 6 weeks by which time she’d caught another and the whole cycle just keep going. Definitely say you aren’t happy and want a referral. When DD had her perpetual cough no one had heard of cough variant asthma and the thinking was if you didn’t wheeze you couldn’t be asthmatic which is not true. It sounds as if she needs some input by a specialist so she can hopefully get an accurate diagnosis and appropriate treatment. It’s just so awful listening to them hacking away hour after hour for weeks on end.

Don't ask for an asthma referral. Because it may well not be asthma. Ask for a referral to a paediatrician, who won't just be thinking "how do I treat asthma" but also "is this asthma, what else do I need to think about".

Possibilities:
Asthma
Recurrent viral wheeze
Rhinitis with posterior nasal drip
Enlarged tonsils
House dust mite allergy
Other allergy
GORD
Vocal cord dysfunction
etc

(And my first question in clinic is always does 4 - 6 puffs make any difference. As if it doesn't, can pretty much park the asthma theory and move on...and if it does, is enough evidence to consider steroid inhaler)

Don't ask for an asthma referral

Peads have to go through the paediatric referral system triage first anyway, that’s a given.