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Ask a doctor
On September 10, 2009 @ 1:08 pm In
Dear Doctor, My 2 ½-year-old son has had a persistent cough for over a month. The pediatrician listened to his chest and said it sounded like asthma. How can she know it’s asthma without doing any tests? How does she know that it isn’t a cold? N.R., Elyria, Ohio
Asthma is described as a reversible disease of the airways. This means that at times you can have obvious symptoms and at other times you may not. With that pattern in mind, a physician can often make the diagnosis on the patient’s history alone. Typical scenarios for having asthma include coughing for more than 10 days after a cold with or without wheezing; wheezing with colds; and coughing, wheezing or shortness of breath with exertion.
On physical examination of an asthma patient with current symptoms, wheezing is the classic asthma indicator. Wheezing is a whistling sound made when air is expelled from the chest. A more subtle sign of an asthma episode may be a “prolonged expiratory phase.” In other words, your child may take significantly longer to get the air out of his lungs (expiratory phase) than he does when breathing in (inspiratory phase). The third type of breath sound frequently associated with asthma is called “ronchi.” These are coarse, almost gurgling sounds made when breathing through the mucus that is so common with the inflammatory part of asthma. Finally, inspiratory “rales,” a sound similar to popping popcorn, is frequently present in pneumonia (which may complicate asthma). A “regular cold,” on the other hand, should not include any of these abnormal chest sounds.
Arthur J. Torre, M.D. Clinical Associate Professor New Jersey Medical School Pediatric/Adolescent Allergy & Asthma Fairfield, NJ
Asthma Versus Croup
“How can I distinguish between asthma and croup symptoms in my 3-year-old son?”
Dear Dr. Strunk, How can I distinguish between asthma and croup symptoms in my 3-year-old son? The doctors never seem to know what to call the 8-10 episodes he has had at night. They have given us albuterol and a nebulizer for the “quick onset of wheezing cough” he also has frequently. I went to the emergency room last night, and even they use both terms. Help! A. N, Garden City, NY
Dear A. N,
Croup and asthma share some common features that may initially make it difficult to differentiate between the two conditions.
Croup is a general term applied to symptoms characterized by a harsh “barking” cough, frequent coughing spells, and varying degrees of respiratory distress. Croup is usually due to a viral infection that causes swelling of the uppermost part of the airway—the trachea (windpipe) and the larynx (voice box). It most often occurs in children under the age of three years.
Asthma is a disease that affects the lower airways. The symptoms of asthma are wheezing and coughing. The asthma cough is deeper than the croup cough, but may sound like an irritant cough.
The diagnostic difficulty comes in children who have recurrent croup, especially as they get older. This type of croup seems to be due to inflammation of the larynx. There is a subset of children with asthma who have inflammation in their larynx rather than in the lower airways. Therefore, these children have a more barking cough with their exacerbation than those with more typical asthma.
As you can see, there are some similarities that make the diagnosis difficult, especially when it is occurring for the first time. Response to medication, and family history of asthma or allergies, often help a physician to make the diagnosis. When symptoms of croupy cough are recurrent, especially if the episodes occur in association with wheezing, it is likely that the condition is asthma. When croup-like cough is the primary symptom of asthma, the treatment is like any other asthma attack, namely bronchodilators and oral or increased doses of inhaled corticosteroids.
Robert Strunk, M.D. Pediatric pulmonologist
Department of Pediatrics Washington University School of Medicine St. Louis, MO
Dear Dr. White,
My daughter is 17 months old and has had eczema since she was born. We have been to several doctors and they all say that she has an extremely high chance of having asthma because of the eczema. Lately she has had a really dry cough and it feels like her chest is rattling, but when I took her to the doctor, he said that it was not asthma. Can asthma be detected at any time or do you actually have to have an “attack” before it can be diagnosed? P.B., Hampton, VA
Cough, particularly with exercise, can be an early symptom of asthma. Alternatively, an allergic child’s cough could be caused by throat irritation or postnasal drip.
In the absence of wheezing, it can be difficult to establish a diagnosis of asthma, but there are a few clues that might help. Children who cough because of asthma may seem short of breath, especially after playing or nursing, or you may notice the child’s skin “pulling in” between the ribs as she breathes. These children’s symptoms decrease after using bronchodilators—medication used to treat the noisy part of asthma such as coughing and wheezing.
On the other hand, children who have a “throaty” cough are more likely to have a runny nose and a cough that responds to antihistamines. Even in these children, the chest may seem to “rattle” because noise and airway turbulence created by a mucousy nose can be “transmitted” to the lungs in small children. When the diagnosis of asthma is uncertain, it’s best to watch the child closely for signs of shortness of breath, especially during episodes of viral upper respiratory infections.
Bronchiolitis and Asthma
“Do infants outgrow bronchiolitis, or does it usually turn into asthma?”
Dear Dr. White,
At the age of two weeks, my son was diagnosed with bronchiolitis. Since that time, he has frequent bouts of wheezing, raspy breathing, colds and stuffy noses. He has also experienced skin rashes, which were diagnosed as milk allergy. I have been told that asthma is sometimes misdiagnosed as bronchiolitis. My son is now 18 months old and only experiences these symptoms on occasion. He now drinks soy milk and avoids other dairy products. Do infants outgrow bronchiolitis, or does it usually turn into asthma? T. J., Southfield, MI
Dear T.J., Bronchiolitis is caused by a viral infection of the bronchial tubes of the lungs and occurs commonly during cold months in infants and toddlers. Recurrent bronchiolitis or bronchiolitis occurring “out of season” is far less common and is more likely to lead to asthma, particularly in children with a family history of asthma. Common triggers of asthma flares in infants and toddlers are viral upper respiratory tract infections and allergies to food and/or indoor allergens, such as animals or dust mites. Babies who only experience asthma symptoms with respiratory infections are less likely to have asthma problems when they are adults than children with more persistent symptoms.
Dear Dr. White,
I have 3-year-old twin sons. Recently, our doctor diagnosed one of the twins, Sam, with bronchial spasms. The doctor said Sam may develop full-blown asthma. We have had two cats in the house for several years. The doctor recommends that we remove the cats from the house to eliminate any potential source of irritant to Sam.
My question: What is the link between allergy and asthma? If we test Sam to see if he is allergic and the results are negative, does that mean the cats are not a problem? D.D., Freeport, IL
Yours is a common and emotionally charged situation. Allergies and asthma are frequently seen together, with approximately 70 percent of people with asthma also having allergies.
Many episodes of asthma that occur in infants and toddlers are triggered by respiratory infections. However, young children who experience asthma symptoms independent of their respiratory infections are often triggered by an allergy to either a food or an allergen in the home, such as dust mites, mold or the family pet. After children reach the age of 4, allergies to outdoor pollens become more prevalent, and by the time children are in elementary school, asthma flares are frequently triggered by allergies as well as exercise, cold air, respiratory infections and irritants such as cigarette smoke.
I would suggest seeing an allergist to determine whether Sam is allergic to the cats and to get guidance on how to manage his asthma. I don’t normally recommend finding a new home for an existing family pet unless there is evidence that the pet is problematic. If Sam is allergic to cats, though, it’s highly likely that the cats are triggering at least some of the asthma symptoms that he’s experiencing. As hard as I know it is to give up a beloved family pet, if Sam is getting sick because of the cats, the most effective way to prevent his cat-induced asthma attacks would be to find them new owners. If Sam has multiple allergies, a future option might be to start allergy shots to reduce the impact of allergies on his lungs.
Dear Dr. White, My daughter is 3½ years old and has asthma. Last summer she didn’t get sick, but now that she’s back in school, she’s sick all the time. Do children with asthma get sick more? How can I help her have a stronger immune system? S.C., Los Angeles, CA
Most children catch infectious viruses at the beginning of the school year, independent of their asthma. Once the body is exposed to a virus, it builds immunity against it, so that we don’t normally get infected with the exact same virus more than once. Allowing ourselves to come into contact with viruses is a normal ingredient in building our body’s immune system.
Unfortunately, upper respiratory tract infections are also common triggers for asthma flares, as is exercise in cold weather. So it’s not unusual for children to require more preventive anti-inflammatory asthma medication in the colder months than in the summer. Good preventive care won’t completely eliminate asthma flares, but it can dampen the attacks and make them a lot easier to treat. Talk to your child’s doctor about whether adjustments need to be made in your child’s treatment plan. Be sure that you have a written, customized asthma action plan that includes what to do if your child develops an infection-related asthma flare.
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URLs in this post:
 How does the doctor know it’s asthma and not a cold?: #How does the doctor know it’s asthma and not a cold?
 How can I distinguish between asthma and croup symptoms in my 3-year-old son?: #How can I distinguish between asthma and croup symptoms in my 3-year-old son
 Can asthma be detected at any time or do you actually have to have an “attack” before it can be diagnosed?: #Can asthma be detected at any time or do you actually have to have an “attack” before it can be diagnosed
 Do infants outgrow bronchiolitis, or does it usually turn into asthma?: #Do infants outgrow bronchiolitis, or does it usually turn into asthma
 What is the link between allergy and asthma?: #My question: What is the link between allergy and asthma
 Do children with asthma get sick more? How can I help my daughter have a stronger immune system?: #Do children with asthma get sick more? How can I help my daughter have a stronger immune system
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