You are currently taking two medications in one pill – Tussionex is a combination cough suppressant (hydrocodone) and a sedating antihistamine (chlorpheniramine). Rather than focusing just on the symptom of your persistent cough, I would recommend that you visit an allergist for a full evaluation of your allergic triggers. Once you know what you are currently allergic to, you can minimize your exposure to those things and, consequently, reduce your coughing. Furthermore, there are newer, powerful, nonsedating antihistamines that can minimize postnasal drip and cough when used in conjunction with an anti-inflammatory nasal spray and leukotriene modifiers. Lastly, depending on the severity of your cough, an asthma inhaler may also be warranted to control it. Q2. My 4-year-old has been diagnosed with cough-variant asthma. We have tried Pulmicort (budesonide), Atrovent (ipratropium bromide), Flovent (fluticasone proprionate), Xopenex (levalbuterol), Orapred (prednisolone sodium phosphate), Claritin (loratadine), Zyrtec (cetirizine) and Nasonex (mometasone furoate). She has gotten worse. Now she is being treated for a sinus infection with Augmentin (amoxicillin clavulanate). Today I finally tried the steam shower, and her cough seems to have quieted for now. Any suggestions? I hate to have my child on so many drugs if they are not helping. Cough-variant asthma is difficult to diagnose and even harder to treat. With this type of asthma, the airways are inflamed enough to cause a cough but not constricted enough to cause the classic wheezing usually associated with asthma. I’m sorry you haven’t had success with the long list of medications you’ve tried. Perhaps the underlying sinus infection resulted in her coughing, and she’ll get some relief now that it’s being treated. Either way, steam can be extremely therapeutic in some patients, so if she is feeling better with the steam, I would keep doing it! Keep talking to your daughter’s doctor about what might be causing her cough and what further treatment options are available. Q3. My doctor recommended prednisone followed by QVAR (HFA beclomethasone dipropionate) for a chronic morning cough. I am very reluctant to go on prednisone, even for 15 days. My chest X-ray was clear, and my spirometry read that I was 145 percent of normal for my age, height and weight. I smoked a pack a day for 15 years but quit 15 years ago. I had a bout of coughing like this in 2000, and it went away (after nearly a year). My question: Could this be cough-variant asthma (CVA)? Is a corticosteroid the only remedy? I’ve got the prescription in hand but keep hoping the cough will end on its own. My doctor has already ruled out the scary stuff like COPD and cancer . Chronic coughis very difficult to treat. Patients often have normal results on spirometry, which records the amount and the rate of air you can breathe in and out. Like the classic asthma symptoms of wheezing and shortness of breath, chronic cough is part of a continuum in how the body responds to inflammation and bronchospasm. The exact reason why a patient responds with a cough instead of a wheeze is being studied. If the cough does not respond to the treatment regimen of inhaled steroids and long-acting beta-agonists, then a short course of oral steroids might be worthwhile in attempting to break the cough cycle. It would also be worthwhile to discuss with your physician exactly what your concerns are surrounding prednisone. It is possible that your fears are justified, but it is equally possible that you may have certain misconceptions that could be clarified by your physician. Q4. I have had asthma and allergies since I was seven years old. I am 49 now. My pulmonologist is recommending that I try Xolair. My breathing is pretty good right now, but I am having problems with chronic congestion and cough. Will Xolair help with those symptoms? Based on the very basic information that you provided, I do not know enough about your current situation to give you an appropriate answer. However, when you state that “My breathing is pretty good right now, but I am having problems with chronic congestion and cough,” it tells me that both your asthma and its related allergic components are not being managed optimally. This may be why your pulmonologist is recommending adding Xolair to your treatment program. When the body senses a foreign substance (such as an allergen) has invaded, it reacts by making many types of chemicals to protect itself. Immunoglobulin E (IgE) is one of these chemicals, and its release can cause allergic and/or asthmatic symptoms. Xolair works by blocking the release of IgE, which in turn helps stop the symptoms. Because the U.S. Food and Drug Administration has approved Xolair for relieving allergic asthma, it seems that this medication might be used as an adjunct to your current therapy to improve the overall control of your asthma and allergy. Better control of your allergy may lead to improved asthma symptoms as well. Because I don’t know your particular situation, however, I suggest before you take Xolair that you ask your doctor to explain more clearly why this medication will be helpful for your specific symptoms. Q5. I had bronchitis two years ago, and I continue to have a cough. The doctors I’ve seen are stumped — they think asthma is the culprit, but nothing helps my cough. I’ve tried inhalers and medicine, but nothing helps. I’ve had allergy tests done, all negative. What should my next step be? — Ellen, New York If you have not already done so, the next step would be to see a pulmonologist — a lung specialist. Chronic cough commonly sends people to pulmonologists, who are usually quite experienced at sorting it out. The most common causes of chronic cough (lasting longer than about two months) in nonsmokers are postnasal drip (mucus running down the back of the throat), asthma, and acid reflux (stomach acid that comes up and irritates the throat). Also, medications for high blood pressure called ACE inhibitors are famous for causing a persistent dry cough. If you are/were a smoker, then a different (and more serious) list of problems must be considered. Assuming that you don’t smoke and aren’t taking an ACE inhibitor, your diagnostic workup will start with the details of your history to see if there is anything to suggest one of the three common causes I mentioned above. Some key questions you have probably already been asked include:
Is your cough dry or wet?Does mucus or phlegm come up?Is there any detectable pattern to the cough: Is it worse first thing in the morning, after meals, with exercise, or when you are trying to go to sleep at night? Does it ever wake you up in the early-morning hours?Can you feel any drainage down the back of your throat?Do you have any nasal or sinus symptoms?Do you ever have symptoms of acid coming up in your throat?Is the cough worse after a spicy or heavy meal?Have you noticed any other unexplained symptoms?
If the answers to these questions suggest a likely cause, a clinician would usually treat you for that problem and see whether you improved. It sounds as if you’ve been treated for asthma without improvement. If cough is your only symptom and asthma medicines didn’t help, I would look for another cause. A chest X-ray or other imaging test would help exclude some lung diseases as well as the dreaded cancers (although these are a very rare cause of cough in nonsmokers). Postnasal drip and acid reflux can both exist without their characteristic symptoms. So identifying these problems may require a sinus CT scan to see if you have some form of chronic sinus disease, or a special test for acid reflux, in which a thin string with a tiny pH monitor is placed in your esophagus (food tube) for a period of time to see if it registers the presence of acid. Some doctors will order these tests early on, while others treat the patient for the presumed problem, and then diagnose it based on response. It sounds as though your cough started with an infection two years ago. That history may prompt the pulmonologist to skip some of the tests I just described and focus instead on a possible complication of that infection. Full pulmonary function tests (besides spirometry, the quick office test in which you blow hard into a machine) may be helpful in sorting out whether you have developed some type of lung disease. The rest of the workup would depend on the results of this testing. Finally, it is possible to find no obvious reason for a chronic cough, even after a lengthy workup. In fact, this is relatively common. When this happens, the doctor may attribute the symptom to an exaggerated sensitivity of the cough reflex. The “cough reflex” refers to the complicated nerve circuit that is responsible for coughing; it involves the brain, spinal cord, lungs, throat, and stomach. Sometimes after bronchitis (infection of the large lung tubes) or pneumonia (infection of the deep lung tissue) — both of which cause inflammation and lots of coughing — this circuit is left in a state of heightened sensitivity, leading to coughing in response to minor everyday irritations that would not normally have caused the person to cough However, an exaggerated cough reflex is a diagnosis that should be made only when other problems have been considered and excluded. Exaggerated cough reflex can be tricky to treat. Dextromethorphan (a pill) or ipratropium bromide (an inhaler) can be helpful. If the cough can be suppressed for a while, the condition usually improves. I hope this information helps you make progress. Q6. My sister got diagnosed with asthma a year ago and takes medication for it. Even so, she coughs all the time. Will she just have to live with the cough, or are there other things she can do? She should see her physician for further evaluation and treatment of her cough. If her physician determines that her cough is due to asthma, they could consider adjusting her asthma medications and possible skin testing to airborne allergens to determine if she has an allergic component to her asthma. Q7. My 5-year-old has never been diagnosed with asthma. However, she has hard recurring cough that sometimes sounds loud and dry. The longest she has been without cough is three months. Would it be a good idea to have her evaluated for allergies or sinusitis? Yes, allergic rhinitis and sinusitis can cause cough. Your daughter should see her physician, who can provide evaluation and treatment for her cough. It could be due to allergic rhinitis, sinusitis or other causes. Learn more in the Everyday Health Asthma Center.
