By Jan Gambino, MEd
When my daughters Rebecca, 15, and Jenna, 18, started coughing last year, I opened the medicine cabinet and reached for the inhalers, peak flow meters and nebulizer as usual. After years of dealing with their asthma, I knew how to wear the Dr. Mom hat pretty well. But this cough was worse than the ones we’d dealt with in the past.
It started out like a cold with coughing and a runny nose, and it hit both girls about the same time. The cough was worse at night, which is typical of asthma in our household, but their peak flow readings were not alarmingly low and there was no wheezing – not typical of asthma. When the cough kept getting worse and worse, we were off to the pediatrician.
It took several trips to the pediatrician and a diagnosis of a sinus infection before we identified exactly what the girls had: whooping cough (pertussis). The clue was when Jenna told our beloved nurse practitioner there was thick mucus in her throat and that whenever she coughed, she couldn’t breathe. Taking a deep breath or laughing was enough to cause a spasm of coughing and breathlessness. The whooping cough was confirmed by a nasal swab test.
Not a thing of the past. I was surprised and alarmed by the diagnosis — I’d thought whooping cough was a disease of the past, something modern-day children didn’t have, thanks to advances in immunization. It turns out that it’s actually on the rise. According to the Centers for Disease Control and Prevention (CDC), there are 5,000-7,000 cases reported each year in the United States, but an epidemic may occur every 3-5 years — in 2005, there were more than 25,000 cases in the U.S.
Whooping cough is a highly contagious respiratory illness caused by the Bordetella pertussis bacteria. It spreads by close contact with an infected person (sharing utensils, kissing, exposure to airborne particles from sneezing, coughing). Some children and adults respond to antibiotics. However, for infants, young children who were premature babies, and high-risk groups such those with asthma or other respiratory conditions, the consequences may be significant.
Many children and adults are underprotected because immunity to the vaccine wanes. Babies and 5-year-olds get a series of combination diphtheria/tetanus/pertussis (DTap) vaccinations, but until 2006 the recommended booster shot for children aged 11-12 contained only tetanus and diphtheria vaccine (Td). That has since been replaced by a booster vaccination containing all three – tetanus, diphtheria and pertussis (Tdap). My daughters had missed this new vaccination.
No funny stuff. Our nurse practitioner said it would take a long time for the cough to go away, since the antibiotics do not affect the course of the disease (but they do limit the spread of the bacteria to others). She was right — we had to cut back on jokes and funny TV shows for weeks to avoid spasms of coughing and breathlessness. The girls stayed home from school until they’d been on antibiotics for a week and our state’s health department helped us assemble a list of friends and relatives who’d been in close contact with the girls while they were contagious, so these people could consult their doctors for a booster shot and antibiotics.
Rebecca and Jenna both have asthma, so their lungs recovered slowly. It was a long time before they could exercise without coughing. This year, it’s almost a relief to get back to the usual wheezing and coughing – but now we’re watching out for H1N1!
Whooping Cough Symptoms
Cough, runny nose, fever
After a week or two:
Cough that brings up mucus
High pitched “whooping” sound after a cough
Nausea, vomiting follow an episode of coughing
Red or blue face from coughing
Bruised or broken ribs from coughing (rare)
Antibiotics prescribed by the doctor
Unfortunately, typical asthma medications have little effect on whooping cough
Oral or inhaled steroids may be prescribed
Eat small, frequent meals
Drink small amounts of liquid throughout the day to stay hydrated and avoid overfilling the stomach
Get plenty of rest throughout the day to make up for frequent night waking.
Stay home until the doctor says you can return to school and work to avoid spreading this highly contagious disease to others.
Stay away from newborns, infants and those with compromised immune systems.
Cover your mouth with your arm or use a tissue to cover your mouth when coughing or sneezing to reduce spread of the Whooping Cough.
Avoid smoke and other asthma triggers.
Written by Jan Gambino, MEd, who has been an AANMA member for many years, is author of Reflux 101 (http://www.refluxmom.com) and a parent educator. She writes a weekly blog for The HealthCentral Network at http://www.healthcentral.com.
First published: Allergy & Asthma Today, Spring 2010 http://www.aanma.org/publication/aat-subscription
Medical editors: Martha Hogan, MD; Michael Mellon, MD