Persistent cough in children with asthma, despite the use of beta-agonists
and steroids, can be difficult to deal with. In my experience there
are usually three factors that can lead to continued coughing in
1) Uncontrolled rhinorrhea. About 90% of asthmatic children have allergic
rhinitis. If this is left uncontrolled they may continue to cough and
wheeze due to the irritation of the postnasal drip. I have found that an
antihistamine-decongestant combined with methscopolamine as a drying agent
to be very useful. This usually stops the postnasal drip and decreases
the irritation causing the cough.
2) Undiagnosed or undertreated sinusitis. Children who have "persistent"
colds or recurrent sore throats (especially after antibiotics) may fall
into this category. Same underlying mechanism that occurs with AR. Besides
the antihistamine-decongestant-methscopolamine combo, I would add
intra-nasal steroids and 3-4 weeks of antibiotics.
3) Vagal mediated cough. I have found ipratropium to be very good at
decreasing or eliminating the cough in asthmatic children. I will send
them home with either the solution for the nebulizer or MDI (with spacer
IMHO, a codeine cough suppressant may not do any more then just make you
sleepier. I think we may do more for our patients by trying to get at the
underlying mechanism that is triggering the cough.
Jeff Linzer MD MICP
Division of Emergency Medicine
Egleston and Hughes Spalding Children's Hospitals
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