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Lung diseases

Allergies, asthma, sinusitis or virus?

01/27/2009

Question:

My thirteen month old daughter has been suffering from congestion for the last two months. She has had no fever or any other signs of illness to accompany this. At the onset we were taking her in weekly to have her pediatrician listen to her lungs to make sure they were clear. After three weeks, and a change in mucus color from clear to cloudy along with a walking pneumonia diagnosis for my husband, our pediatrician decided to treat her with amoxicillan for ten days. Following this was another ten days of augmentin as the congestion was still present. We then were prescribed omnicef for another ten days as the doctor then ordered a chest xray to be on the safe side and the results showed a possible early pneumonia. Keep in mind that my husband also took three different antibiotics as well, and ended with omnicef. After the omnicef we went in again as she was still congested and the doctor said she was slightly wheezing, so she prescribed albutoral (sp?) nebulizing every six hours for what went on for about one week. She also prescribed prednisone for five days. We just had a follow up xray after this treatment and it was clear, however my daughter is still congested. She doesnt have a runny nose, and hasn`t really for the most part. She just has this chest congestion, that of course we can hear when she coughs. Her cough is also by no means chronic or debilitating and she is otherwise fine. She does not look ill at all. I asked the doc today what we will do if her congestion does not go away and she said we may have to explore the possiblity that she may have allergies. This has been an especially virulent flu and cold season where we live, as most people, my husband included is still coughing up junk from time to time and not quite feeling a hundred percent. Added to this is the fact that we have recently renovated our home and my husband thinks that the grout dust may be a factor. What do you think?

Answer:

I'm going to assume that when you say "congested" you mean that there is a sensation that something is rattling in your daughter's chest - and not that she solely has a stuffy nose (nasal congestion.)  

It can be tough to tell if a "congested" sound in a young child is being caused by air moving through mucus in the throat, windpipe, or deeper down in the lung.  When it's accompanied by cough, and has been going on for more than 3 weeks, the usual concerns are that the noise is from:

1)  Stuff draining down from the nose and catching in the throat*
2)  Asthma (some kids with asthma make a lot of lung mucus)
3)  Stuff coming up from the stomach and getting caught in the airway (reflux)

* The most common reason for #1 at this age is a persistent nasal infection (bacterial sinus infection), although back to back viral infections and allergies might also cause it. 

Whether or not your daughter got temporarily better on the antibiotics or steroids would be a helpful clue.  If the Omnicef did finally clear her up, but then the symptoms came back within a week, the problem may be sinusitis - which can be notoriously hard to clear up (it "hides" in the nooks and crannies of the sinuses, and sometimes takes a double course of antibiotics to get rid of.)  

If the prednisone cleared her up, but now the symptoms are back, I would be more concerned that she actually is having an asthma problem.  She might benefit from using daily inhaled steroids through the rest of the winter (at least).  The remodeling dust could irritate this type of trouble.

If neither the antibiotics or the steroids have even made a dent in the problem, then I'd be more worried about recurrent viruses, or the reflux problem.  If it's viral, she should be gradually getting better.  If not, sometimes it takes trying some acid suppressing medicine for a couple weeks looking for a response.  (There are reflux tests out there, but they're either not very accurate or not very pleasant to go through.)

Whether to simply sit back and wait to see what will happen, or pursue more treatments or tests does depend on how concerning her appearance/exam have been over the course of this illness. And if there are other problems - like weight loss, persistent fevers, etc., that opens a whole other set of concerns.  Those are issues your child's doctor is really in the best position to judge.

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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