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Lung diseases

Bronchiolitis in children

01/21/2009

Question:

My daughter is 5 years old and one year ago she had her first bronchiolitis diagnosis. She has started school this year and has been sick since the end of Aug. She`s had bronchilitis again and her cough doesn`t seem to go away completely and she gets sick (cough, runny nose, fever that ranges from 100-103) every few weeks or so. Antibiotics seem to not help at all and this really worries me. Her pediatrician says her lungs sound clear and since she usually doesn`t cough during the exam, he thinks I`m just worrying too much. Anthing I can do at home to help her get over this.

Answer:

It sounds like the most consistent symptom your daughter is having is a chronic cough. In children who are otherwise healthy, a steady (or waxing and waning) cough is usually due to one of 3 major problems:

1. chronic nasal drainage (often due to sinus infection or allergy)

2. asthma (even when there is no wheezing)

3. gastroesophageal reflux (stomach contents backing up in the esophagus)

Sometimes more than one of these problems can be present.

Most of the time when chronic nasal drainage is the culprit, the child also has problems like frequent runny nose. If sinus infection is involved, there might be off and on fevers, and usually at least temporary improvement with antibiotics. A sinus CT can help evaluate for sinus infection if the story is unclear. Allergy testing can sometimes be helpful too (although keep in mind that many children with asthma also have allergies - so a positive test doesn't necessarily mean the only problem is in the nose.)

If the child has a history of wheezing at any time (which usually is why the label "bronchiolitis" is made on a chest illness), then the chances of asthma being involved go up sharply. Since the most potent way to set off an asthma flare is a cold, there may be low grade fever involved with these episodes, too. It is possible to be coughing because of asthma - even though no one hears wheezing. At five years old, doing testing for asthma (special breathing tests) can be difficult - the diagnosis is often "made" by simply treating the child with asthma medications and seeing if they help.

Finally, gastroesophageal reflux (reflux for short) can be a particularly tricky cause of coughing to diagnose. Sometimes the kids will report stomach or chest pains, or that they have "mini-throw ups," but not always. Often you have to go after this diagnosis with tests or trials of medicine "on a hunch."

Given your child's history of at least 2 episodes of wheezy chest illness, and the failure of antibiotics to help her symptoms, it's probably time to consider asthma as a possible source of her troubles.

Unfortunately, there are not any good home remedies for this. You may need to go back to your doctor, point out that she's still coughing, remind him/her of the "bronchiolitis" episodes, and ask about the possibility of asthma. A trial of asthma medicines would be a likely next step.

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Response by:

Elizabeth D Allen, MD Elizabeth D Allen, MD
Clinical Associate Professor of Pediatrics
College of Medicine
The Ohio State University