Do inhalers really help with night time coughing?

[foxinsocks]

We have unfortunately hit another cycle of dd's night time coughing. More often than not, it will follow her having a cold or sometimes it seems to me to be triggered by hayfever (not this time, but I expect we'll get another round of it in June).

She is on becotide and ventolin. We can up her dose of both when needed up to 3 puffs of becotide twice a day (and the ventolin when needed). Although she is coughing during the day and after exercise, I would say she's not badly out of breath at all in fact, I have definitely seen her worse.

My concern is the following - dd is 5 in August and STILL the GP is saying she is too young to be diagnosed asthmatic. I am almost convinced she is (dh is asthmatic, I was as a child) but there is still a niggly doubt in my mind as the doctor has never heard a wheeze in her chest and her cough at night does not sound that wheezy to me (though there are times when it does).

I think the becotide might help but I am wondering whether it is just coincidence that after a month of upping her dose the coughing stops and that if I didn't up the dose, it may stop of it's own accord.

Does anyone else have a persistent problem with night time coughs?

Hello - I have had this problem with dd - 3.4, she started off with a cold the december before last and it never went away. She coughed through the night and first thing in the morning to the point of being sick.

She has had sooo many appointments with the doc who told us to just get rid of the cats. Her cough went away through the summer after a dose of anti-biotics (possibly just a coincidence) but she got another cold in December and the cough stayed again.
She is now on becotide and ventolin too but i hate giving it to her so often - meant to be 4 times a day!!
Her cough has now gone again since the weather is warming up but I don't know of that's just because it's warming up or the inhalers. I havent given her either of them for a few weeks now. We have got an appointment in June with a paed who specialises in asthma so am really looking forward to what she has to say.

DD has had chest x-rays as well which all showed up clear.

Yes.
DD, 3.5. has had a bad night cough since around 1 yr. We were on all the inhalers, and though it sometimes faded for weeks or months (and indeed we dropped inhalers in the summer) nothing seemed to make a difference after winter colds. The coughs would drag on at night for months. Everyone's sleep was up spout.
She also never sounded 'wheezy' to any docs but still they went on advising us to stick to the inhalers. It got so bad that last autumn, we were told to up her doses and to introduce a 3rd inhaler. I dug in heels, then we got an x-ray and referred to a paed who chased her around the hospital courtyard (she still talks about him lovingly) and he said her cough is not asthmatic. He said she has a susceptibility to low-level irritation in her lungs after colds, and prescribed paediatric codeine. Now whenever she gets a cough we whip out the brown bottle. She still has a tendency to be 'coughy', but this is definitely much more effective than the inhalers were.
Maybe worth asking for x-ray and referral?

(the x-ray showed irritation in her lungs, very similar to what they'd have expected in an asthmatic, which is why i'm glad the paed took a real look at her)

would an X-ray be able to show whether it was this irritability then?

My sister (much younger than me!) had to have paediatric codeine for her coughing. What bothers me is that if they said to me, yes, it's definitely asthma then I would give her the inhalers but I hate giving her stuff when they are not even sure what she has.

We have got so used to her coughing at night now that it's hard to guage how bad it is (if you see what I mean!).

oops sorry, you answered my question before I posted.

I will ask the GP. Luckily we have a local hospital that does X-rays so I'm sure it cannot be a huge deal to get her referred for one. If she won't do it, I'll insist on seeing a paed because I really do not want to pump her full of stuff that may not be helping her at all.

Thanks both of you for your help.

yes, you need an ace paed to look at the x-ray and her together.

I know, i hated piping the stuff into her willynilly. last straw was when GP prescribed this 3rd inhaler which i found out later was only for children 5+. He later apologised, but i thought that was really shocking.

it pisses me off really because she has had inhalers for years. Also when she was seeing a paed for her allergies (between the ages of 1 and 2 and a half) they were more than happy to hand out inhalers to us with the 'oh she's atopic, she's more likely to have asthma' card. I mean, she either has it or she doesn't in my view.

are you in London?

As an asthmatic I can feel a real difference when I remember to keep the becotide up in cold season. I may still get the night cough/chest tightness even so, but it is much better than would have been otherwise, so please keep it up. It's very difficult to tell by symptoms whether it's helping until the child is able to describe it themselves, unfortunately. I think I've mentioned before about being accused of "faking it" but there's a whole range of symptoms that you can "feel" before there's an audible wheeze or cough.

It's worth remembering that becotide (whether an upped dose or starting from scratch) takes up to about 2 weeks to kick in properly - so be aware of that delay. Becotide is also much much better to be taking on a regular basis than ventolin - it's why preventors are plugged so heavily over relievers.

That said, both drugs have been used a very long time and have excellent safety record and very few side effects. And it is far far better and safer for them to have their asthma well managed - asthma can really have very minimal effect on people's lives these days when the right dosage of medication has been found and it is being used correctly.

There's an excellent website with lots of information for parents and sufferers called Asthma UK - it's worth a good read, and a particular must-read of the site is what to do in the case of an attack. Hopefully, you'll never need to use it, but very worth while having the knowledge.

foxinsocks: re the age of diagnosis - tough one. I'm fairly certain from things my mum said that I had asthma from pretty young, but I think "official" diagnosis I was nearer 7 or 8... unsure about diagnosis today. I know when ds1 was suspected asthmatic that I was told it was impossible before the age of 3 at the earliest because there was another condition which manifested itself in almost identical ways (and was treated the same) but wasn't actually true asthma. Unfortunately, I wasn't listening properly at the time to find out what the alternative condition was called - doh!

Just want to end my horribly long ramble by saying yet again, please don't feel bad about giving the inhalers (particularly the preventor - becotide). It really is SO important to keep asthma properly controlled and does make the sufferer so much more comfortable. It's truly terrifying not to be able to breathe properly.

Meant to add - there's also an Asthma helpline run by nurses who are specialists in asthma. Maybe you could chat to them about your concerns about diagnosis and they could reassure you about the particular inhalers you have been prescribed? The number is 08457 01 02 03

Found a section on diagnosis of asthma for the under 5s:

Diagnosing asthma in very young children can be difficult because:

at least one child in seven will have ?wheezing' at some point during their first five years. Many of these children will not go on to have asthma in later childhood, so your doctor may not want to use the term ?asthma' at this stage.

it is not easy to measure how well a young child's lungs are working. A peak flow meter is used for older children, but is unsuitable for children under the age of six.

The pattern of symptoms that develops over time shows whether a child has asthma or not. Your doctor may ask you to keep a record of your child's symptoms and when they happen. This will help the doctor get to the bottom of your child's breathing problems.

If your child is under the age of two, it is even more difficult to tell if they have asthma. There are a number of different wheezing illnesses, including acute bronchiolitis, ?wheezy bronchitis', as well as asthma, which can make your baby wheezy.

(Full document can be found here and is a really good read)

thanks georgina. I'm not going to stop giving them to her it's just that I would rather have a diagnosis. What annoys me is that at first they said she would have to be 4 and then they said she would have to be older. So it seems like a moving target (to be diagnosed asthmatic). I'm sure she could do a peak flow now (i can remember doing them myself) so I'm going to try and insist they test her.

I just don't want to find out in a few months time that this wasn't asthma and we could have been doing something else. On the other hand, I do think I'm clutching at straws because I'm sure the likelihood is that she is asthmatic. If she is then I'm guessing they need to seriously up her dose or change her inhalers because the poor child suffers terribly coughing for hours at night.

No, I appreciate that - it must vary from child to child how easy they find the peak flow thing. I'm fairly certain ds1 would not be able to manage one (he's 4 in May)...

It does sound that whatever she's got it's not being controlled well. When do you have your next appointment? Might the helpline have more information that you might be able to take back to your GP?

having read that document georgina, I think I will keep a diary of her symptoms - how long she coughs at night etc. What complicates matters is that she has been getting croup (in addition to her normal coughing) and that makes it hard to distinguish between 'wheezing' and that awful croup noise at the top of their throats.

I think I'll keep a diary for a week then go to the GP and see what she suggests.

we have an asthma nurse who's great but I think now that she is at full time school (she's been doing part time till this term), it's become more critical because she has less time to recover. Beforehand, if she coughed for 4 hours at night, she would go to school and then collapse in the afternoon. Now she has to last the whole day and she is really beginning to suffer. The asthma nurse is lovely but can't really prescribe anything and starts off on the assumption that she is asthmatic!

Even the school are bugging me now because they want me to leave an inhaler there if she is asthmatic (she's not needing it at school yet) but it means I would have to come in and give it to her. I have told them she may not be asthmatic (and they look at me as if I'm mad for giving her the inhalers then!).

Sounds a good plan

Sympathies with the croup - I remember that being hellish when ds1 had it. Hope she's feeling a lot better soon.

Also, when/if she does get a diagnosis, my top tip is to bypass the GP completely and go straight to the asthma clinic nurse at your surgery. They're usually MUCH more clued up, and much better with advise on dosage, how to use them properly and everything. I remember getting called to one in my early 20s, muttering that I'd been asthmatic for a couple of decades now and knew what to do thankyouverymuch, only to discover I'd been using my inhalers wrong for most of that time (you're supposed to hold your breath for a count of 10 and I'd got all blase and just taken a quick puff when needed... funnily enough, my asthma got a lot better after that visit )

Oops, cross posted. Lol at the school looking at you as if you're mad . Any chance of seeing a different GP at the surgery at all? Or can you push to be referred once you've got your symptoms diary?

The GP we normally see is OK but as she has never heard dd wheeze (and I guess this is the definitive test) she is reluctant to say, yes she definitely has asthma. All the symptoms I describe fit perfectly though but as bakedpotato was saying, they also fit with having a long-term irritable cough.

I will go to her with the diary and ask for an X-ray (and to be referred). I'm not frightened of being pushy and as dd has had to see several paediatricians in the past (she had hernia surgery), I'm sure they can find one that still has notes for her!

Thanks for your help.

No problem - would like to be updated on how you get on if you get a chance/remember

I will definitely update you.

I have the pleasure of trying to get a GP appointment first though - we have one of those systems where you phone up on the day. It's normally madness and quite often, I have to take a break from it before I literally throw the phone at the wall and then get given the most inconvenient time (normally meaning both kids miss some part of school!).

just to let you know Georgina

I had a quick chat to the asthma nurse. She suggested that we up dd's inhalers as we were still giving her the minimum dose. We upped the beclomethasone quite substantially and within 2 days of doing this, her coughing improved quite substantially.

Although I'm pleased this worked, it does make me a bit sad as I think it is pretty much a sign that she does have asthma (despite anyone formally diagnosing her yet).

We (nurse and I) have decided to continue with the max dose of beclomethasone for a few more weeks (this is always dd's worst time of year) and then take her to the GP to review the situation to see whether it's worth reducing the dose again or whether her inhalers need to be changed (if the cough has gone). This time, for the first time, I have put my head on dd's chest and could actually hear her wheezing poor thing.

Anyway, all in all, I'm pleased this has worked and dd is sleeping much better. Thanks for your help. That document about not diagnosing them formally till they are much older was particularly helpful.

I'm glad in a bitter sweet sort of way. I'm glad that she's now comfortable and that the medication is working well.

I will try and offer some reassurance though that just because she's on a higher dose now, doesn't mean that she'll be on a higher dose all the time. I hardly take my preventer or reliever now (I step up preventor use during the winter cold season or if I start feeling the need for a reliever) and many children do grow out of asthma completely by the time they reach adulthood.

Thanks for the update, btw - really nice to know how you're both getting on.

Oh, also meant to say, it sounds like you've got a good nurse there - always handy