Chronic cough in 7 year old

[IndecisiveRabbit]

Hello all, just looking for any thoughts on my son's chronic cough. He's had it for a year now, started last July after a nasty virus with rash, temp, vomiting etc. GP thought maybe cough variant asthma, tried inhaler, no change. Saw private paediatrician who though it could be reflux as also gets nausea sometimes, is a fussy eater, and I have it, so tried omeprazole, no change. Also considered allergies, so tried antihistamines, no change. Looked into immune system issues due to frequent infections but bloods look ok, as did all general blood tests, apart from raised tsh so possible thyroid issue. Also had 2 chest x rays, first showed signs of bronchial wall thickening due to resolving infection, but latest was fine. Just saw nhs paediatrician who has recommended trying steroid nasal spray as may be a sinus issue (he also has lots of perforated ear drums and infections, on list for grommets). Dry cough with lots of throat clearing and sniffing/snucking. Have been reading an interesting book on the cough enigma and vagus nerve damage. Any thoughts welcome! Thank you

When you say you tried an inhaler, did you have a steroid inhaler, or just the salbutamol one?

I’ve read the book the Chronic Cough Enigma too. It turned out that my cough was due to bronchiectasis. It might be worth considering that. It’s diagnosed via a CT scan. The GPs keep referring for X-rays, but can’t refer for a CT scan (in adults, anyway). There are many mothers of young children in my bronchiectasis Facebook group. Most of us don’t know why we have it, though for some there’s a genetic reason, others have had chest infections. Many of us have acid reflux. I don’t cough very much now.

Sorry for the delay, finally all kids in bed and work finished! It was just the salbutamol one. The NHS pediatric consultants wouldn't see him initially, and just suggested trying it to our GP. He was on it for about 3 weeks. Then we saw a consultant privately, who felt it was more likely to be allergies/reflux so took him off the inhaler and put him on the omeprazole and antihistamines. Do you think it could be worth trying a steroid inhaler?

Did he always drink water after having the inhaler? As they can make you cough if not, ironically. Have you tried honey and lemon?

Thank you for your reply, I've heard of this and I'll have a look into it, I'm glad you've got yours under control. He's just started the steroid nasal spray so I'll give that a week or two but I'd really like him to see a respiratory specialist, can't believe how long it all takes.

No he didn't have water after the inhaler, that's interesting, thank you. Yes we tried honey and lemon, and things like throat sweets at the beginning when we thought it was just the after effects of a nasty cold, but it didn't seem to help.

Do you think it could be worth trying a steroid inhaler?

Absolutely. I see no reason why you can’t have a 4 week trial. Even if it doesn’t work, you’ve discounted it, and he’s had an awful lot of investigations.
My DS’s only symptom of asthma was the throat clearing/sniffing, with an occasional cough. The throat clearing was so annoying!

Did they test peak flow?

this is how my sons asthma was diagnosed

asthma uk are very helpful.

I had this cough for nine months and it only got resolved after an ENT put a camera down my throat. I had silent reflux which gave severe inflammation in my throat. While I was taking omeprazole for reflux, it did nothing for inflammation.
What helped me was Gaviscon Advance. Coated my throat and protected from further acid attack. I was also asked to stop anything acidic (even tomatoes) and spicy for a week.
The cough improved drastically in a week and completely went away after 3 weeks. My dosage was 2 teaspoons after every meal, 2 teaspoons after every cough attack and further 2 teaspoons before going to bed. Inclining the bed also helped.

*Forgot to add: mine started after Covid, the GP first thought it was asthma, then long Covid, then gave me a referral for ENT.

Could it have become a habit or tic rather than a "real" cough? Throat clearing or coughing are common tics at this age.

www.nhs.uk/conditions/tics/

I was going to say the same as the PP. The throat clearing you mentioned made me wonder if it was a tic or a habit cough.

Virus induced asthma. Probably requires a brown inhaler or when you use the blue one one puff then 5 mins later a second one
Dd1 has this and we found only one puff isn't quite enough by age 7/8 as they still use the spacer

It really is annoying! And it's starting to upset him too, so I really want to sort it out. Thanks I'll talk to the GP about this.

The GP did once at the surgery and the results were fine, though maybe it needs to be done over a longer period, something I can ask thanks.

That's interesting thanks- the omeprazole didn't seem to help him, but I'd said at the time that when I had reflux myself, omeprazole wasn't enough either, I'd had to take another medication to control it. So that could still be the issue.

I did read about that thank you, but when he does the sniffing/snucking it does sound like he's clearing it out sometimes, so I feel like there's genuinely something causing the coughing.

Thank you, I do think we need to look into the asthma angle again, we didn't try it for long.

My dd has cough variant asthma. She has a brown steroid inhaler twice a day and a blue one when she needs it which is rarely as the brown one controls it really well.

before the brown inhaler she was constantly coughing and was being woken up at night by it distressed

Fine meaning correct level for his age?

Actually I think it’s height based

The other way they test is to do a peak flow best of 3, administer the blue inhaler with a Spacer and wait around 10 mins and then check peak flow again. If it’s raised by a certain amount it’s indicative of asthma and brown inhaler is needed.

Ah OK, the GP just did it once and said it was fine, it was a "let's quickly check this" at the end of an appointment, I think I need to go back and ask for a more thorough look at this. Thank you

If not to at least rule out properly.

i found asthma uk extremely helpful - their helpline.

I was late diagnosed and the GPs didn’t diagnose me; I had to ring the surgery and ask to be seen by the asthma nurse. I had to explain that asthma uk (and a trained asthma nurse friend) had suggested I get properly tested. It turns out I did/ do have asthma. The nurse did actually leave in the middle of my appt with her, quite thin lipped and grumpy, after she’d tested me and “talked” to the gp. He had said that maybe I just needed a blue inhaler occasionally. She was not impressed. Starting the daily brown made a huge difference to me. I don’t wheeze.

my eldest son was also diagnosed around age 5/6 but I knew the signs and took him straight to the nurse. She had to refer him back to the gp for a formal diagnosis on record but effectively also diagnosed him.

it may not be of course but it’s best to be sure as it can get much worse if not treated.

Often waking around 2 am to cough is a classic common sign too.

Thank you, I am definitely going to go back and ask about this. It's difficult isn't it as there could be so many causes of a chronic cough, and every GP/ consultant seems to have a different opinion, and I was fobbed off for months with " oh it'll go away soon", it wasn't until we saw someone privately that the nhs consultants would even agree to see him. Frustrating. I'll also contact asthma UK. Thank you.