I have asthma. Papa Tree has asthma. Usually it just occurs when we exercise- which means we haven’t had any asthma problems for the last 2 years! (that’s another story!) However, Willow had some wheezing episodes this winter. We have wondered if it might be the first sign of asthma. Dr. Gilgoff has some good insight into the types of coughs and wheezes your child can have and what they might mean and what you can do.
The cough that won’t go away: when to consider asthma?
by Dr. Gilgoff
Looking back over the past few months (was that a long winter, or is it just me?), we saw so many coughs and colds. While the majority of coughs stem from a viral upper respiratory infection, and therefore will get better with time, there are some causes of chronic cough that you don’t want to miss. As doctors, we are synthesizing data from your history – including family history, present illness, physical examination and occasionally laboratory data and or ancillary tests. Making an asthma diagnosis is a classic example of having to put the whole story together carefully. You never want to over-diagnose asthma – but you don’t want to miss it either!
Asthma is a type of sensitivity. A child with asthma has hyper-reactive airways, meaning that certain stimuli (dust, cigarette smoke, mold, cats, cockroaches etc.) will trigger a reaction in the lungs. For a long time we knew that the reaction involved a constriction of the lung’s small airways (called bronchioles), and indeed patients feel “tight” and have difficulty breathing. But there also is an enormous inflammatory component to asthma, and this contributes greatly to the disease process. Certain conditions run together, and often people with asthma have dry skin or eczema and allergies. Sometimes a baby will develop all three at an early age, and we are investigating ways to prevent what we call the “atopic march” – seeing if we can actually prevent asthma from coming out in the child with a strong family history who already shows signs of eczema and allergies but hasn’t yet wheezed.
When evaluating a child for asthma, the family history is important, as this often (but not always) runs in a family. Of course, the physical exam is of the utmost importance, as we are listening to see if we hear a tightening or wheezing of the lower airways. Sometimes however, you can have a normal lung exam and still have mild asthma. When a child young, (usually less than one year), there are certain viruses that can cause wheezes – so not all wheezes are asthma! But if a child continues to wheeze as they get older, they may have asthma. There is a test for asthma called spirometry, or pulmonary function tests, but these tests are effort dependent, and therefore usually only valid after 5 or 6 years old. For the younger child then, it is a clinical diagnosis that you and your doctor will entertain if the cough is “tight”, non-productive, or lingering for too long. Other signs of asthma may be a night time cough, or cough that accompanies exercise or laughing.
Other common causes of a chronic cough are sinusitis, post-nasal drip, a host of viruses, pertussis (whooping cough), walking pneumonia, and even acid reflux. It is normal for a common cold to leave behind a mild cough for up to 10-14 days, but if you see your child suffering with a cough for more than 2 weeks, they should be evaluated by a doctor. Sometimes an x-ray is necessary, but we don’t want to over-expose children to radiation either – so usually we get one and then try to hold off on getting any more.
The mainstay for asthma treatment is bronchodilators – medicines that open the lungs. Albuterol is the most common medicine (also called proventil, ventolin, proair, maxair) and you can give it orally, inhaled in a pump, or in a nebulizer machine. The oral solution really shouldn’t be used often as there are more side effects. The pump needs to be used in conjunction with a spacer device in order to get the medicine to the lungs. And the nebulizer can be used for any age, but takes a good 15 minutes to set up administer and clean. Xopenex is a new Albuterol type medicine that is also very effective. The other medicines are anti-inflammatory medicines and include singulair (a mild medicine that is not a steroid and can actually help with allergies as well), and a good number of steroid based medicines – such as Pulmicort, Flovent, Advair etc. There have been so many scientific studies showing that only a trace amount of steroid medicine will be absorbed into a child’s system if we use the pump or nebulizer correctly, – but your doctor will discuss the risks and benefits of each medicine they prescribe. We doctors also hate side effects – but untreated asthma is very dangerous as well!
If asthma is left untreated it will progress, and unfortunately asthma still takes the lives of many adults and children. If your child ever exhibits any signs of respiratory distress, with the chest wall or stomach going in and out too rapidly, you must go to the emergency room immediately. A phone call to the doctor is never a bad idea, but when you are talking about breathing problems, the doctor needs to conduct a face to face assessment, and if the child is already in distress, it is not wise to wait until the morning.
Dealing with a diagnosis of asthma can be frustrating. The coming and going nature of any chronic disease can wear down both parent and child. Fortunately, most cases of childhood asthma will get better, or fully resolve in the late teens or adulthood.
*Cold medicines – whether Robitussin, Dimetap, Sudafed, Triaminic, or any Tylenol or Motrin “plus” (added cold medicines) are just not effective and have a real risk of side effects or overdose. So please stay away from these medicines!
**If you think your child may have asthma, or if they have had a cold or cough that just won’t go away, speak to your pediatrician. Dr. Gilgoff is always available for a consultation, or second opinion, and there are great pediatric pulmonary specialists in the community as well.
Dr. Gilgoff is a pediatrician relatively new to the Brooklyn community. He has a balanced approach to medicine, combining a western training at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a Doula company since 1987. Dr. Gilgoff worked in Manhattan for 11 years, and now practices on 185 Montague Street. Dr. Gilgoff is available for free prenatal consults, second opinions, and accepts new patients with all types of insurance plans.
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