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Wednesday, November 26, 2014
Coughing and Asthma
My 9 year old has environmental allergies which give him sinus and eye symptoms and also severe food allergies so he always has an Epi-Pen handy. He also gets terrible coughing when he has a cold or illness or sometimes just for whatever reason. He uses Albuterol and Flovent when he gets this coughing and it relieves it. I use a peak flow meter to monitor it. However, he doesn`t wheeze. The allergist considers this coughing to be asthma. The pediatrician does not. Why this discrepancy?
Children with allergies, especially when they are severe allergies, often have very reactive or "twitchy" airways when they get upper respiratory tract infections. They also can have respiratory symptoms when exposed to other triggers such as exercise or various environmental stimuli. The fact that your child gets relief when he uses a short-acting bronchodilator such as albuterol and an anti-inflammatory inhaler like Flovent indicates that he has twitchy airways and has airways that are inflamed. These are symptoms of asthma. The fact that he has severe allergies furthermore increases the likelihood that he has asthma. The presence or absence of wheezing is not a specific or sensitive marker of asthma. Patients with severe asthma may not have audible wheezing. Asthma is diagnosed by clinical history and objective pulmonary function testing- not by physical exam. I agree with the allergist and recommend that you son sees a pulmonologist to be evaluated for asthma. Asthma can be well-controlled when it is treated properly.
Jonathan P Parsons, MD, MSc
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University