Understanding Cough Variant Asthma

Dr. Tommy... I pulled my info from the asthma guidelines and expert sites such as AAAAI.org. So, I was interested to read that you have such a different take on things. Do you have any reliable source material to refer me to that would back up your theories, so that I can give our readers a more balanced view? I'd love to read more about this...

Start with almost every Asthma survey and the most common symptom by far is cough, not wheezing. Therefore, if cough is the most common symptom, why is that not emphasized more. Most of the time it is easily identifiable chesty, whether productive or tight and wheezy.

The rest of my observations are just that. A perfect example was a mother yesterday. Her son was diagnosed with asthma and responded to Xopenex and Pulmicort each time. She had Asthma as a child but "outgrew it". Now she gets "chest colds" and "bronchitis" never put on inhalers again (per her words), it is the same cough my son gets but hers lingers for days or weeks no matter what antibiotic or cough suppressant she is given. She also starts coughing when she laughs too hard or tries to go up You tell me what she has up stairs during these times. You tell me what she has.

I don't have much in the literature. I will try to look it up later but one I remember is I believe out of a Phoenix, AZ longitudinal study that in the early 20's an increasing number of "wheezers" as infants developed Asthma. Did they develop Asthma or was their symptoms, e.g., EIA or "bronchitis" or coughing episodes, just missed.

The problem in the literature is, so many times, the studies are looking for other causes of cough despite them saying that the most common cause of chronic or recurrent cough is asthma. I have never seen a study treating this type of patient with bronchial dialators and some with placebos and see who improves the best. All I can tell you is in my office, they do respond with nebulizers almost immediately.

I am a clinician not a researcher so haven't done the study. All I can tell you is that I treat as many asthmatics as many specialists and despite this I have one of the fewest admission rates tcompared to my fellow pediaticians per all the insurance companies data when presented to me. I must be doing something right.

I have to some what agree with you, I am 53 and coughing is the worst, I have rarely whizzed. If I laugh I cough, If I get to hot I cough, but where they say it is the only symptom, no way. We suffer with shortness of breath, tight chest, and chest pain, but summer is the worst season, I can't wait till the weather cools off. Can't stand to be cold but I can breath so much better in the winter. The mistake to me is when any doctor tries to put every patient in the same little box of symptoms, no two people are alike and why in the world doctors believe that every patients body is going to react the same.( It's like if your symptom is not on the list for this then you don't have that) I'm having an extremely hard time with mine right now and have a hand full of meds but if I walk around or talk I cough, no matter how much I inhale or take. It would greatly help if people were looked at as individuals not just certain things on a list. I was diagnossed years ago, they need to update their list.

I suspect that my 74 year old husband has CVA.  He started his chronic cough in December, 2008.  After a couple of months went to the doc and had chest/lung xray, various heart EKG tests, and complete physical.  Everything better  than normal for his age.  

His cough is worse in the morning, and then subsides and goes away completely during the day.  It picks up in the late afternoon, and especially when he drinks red wine before dinner.  Then coughs off and on all evening.  The cough is loose and rather "harsh".  He says that during the night he can hear wheezing sounds in his chest.  

Does this sound like CVA??

With my son his coughs are just a dry hacking cough. Sometimes my sons cough will last weeks, continuous except for when he goes to sleep. He may cough a couple times during the night during the the times his coughs are so bad but the night coughs are rare. From what i am told if there is wheezing with the coughing it is regualr asthma and no wheezing is what makes the CVA different as that sympton is not there.

Hi - thanks for responding.  I guess I put my question in the wrong place. I think I should copy and repost it?

It must be very hard for you to deal with your son's asthma. I used to worry about my three children all the time.  Now they are grown up adults and I still worry about them constantly - especially my youngest daughter.  It is something that never ends.  

I sincerely hope that your son outgrows his asthma. I have heard that may children do.

Best wishes to you and to your son.