That nagging, hacking cough can play a trick on some parents.
There’s no fever, and the cough comes and goes, seemingly triggered by the getting-ready-for-bed routine. A skeptic might think it’s an “excuse cough” — notice how it can quiet down if you let that moody, sluggish kid stay home from school?
Don’t be fooled into thinking it’s nothing serious, health officials warn. Frequent intermittent coughing — particularly at bedtime and upon rising — is a classic sign of childhood asthma.
“Nobody should be coughing at night for more than five or six days,” said Beth VanCleave, asthma educator for Norton Children’s Hospital.
Asthma is responsible for more than 6,000 hospitalizations a year in Kentucky. It is the most common diagnosis among hospitalized children and the leading cause of emergency room visits and school absenteeism.
“Asthma used to be called ‘the nighttime disease,’’’ VanCleave said, explaining that swollen bronchial tubes can become plugged by mucus when a person is resting or lying down, making it difficult to breathe effectively.
Sometimes, seasonal allergies or the common cold can trigger asthma symptoms, so it can be tricky for parents to know whether their child is coughing and wheezing from allergies, a cold or something else.
Before making an asthma diagnosis, your child’s pediatrician will usually do a physical exam, ask about symptoms and overall health, and do some basic breathing tests. The doctor may ask about when and where symptoms occur, whether anyone in the house smokes, if the family has pets in the home and whether the child or any relatives has allergies or hay fever.
Your pediatrician can do a basic test, called spirometry, to measure for resistance and restriction in the lungs. The test is quick and painless — your child will simply take a deep breath and then blow into the spirometer’s mouthpiece, which is linked to a computer.
Some spirometers use the on-screen image of a birthday cake, with blazing candles that “go out” as the child blows.
After the initial test, the child will be given a bronchodilator, which is an inhaled drug that opens lung airways. Then the child breathes into the spirometer again, and the “before” and “after” tests are compared. If the post-medicine tests show improvement, it indicates asthma could be narrowing the child’s airways.
“The reversibility is the hallmark of asthma. You take some Albuterol, and you reverse the condition,” said VanCleave.
A variety of medications are available to control both long-term symptoms and immediate emergency symptoms, frequently called “asthma attacks.” Doctors generally decide what type of medications are needed and when those medicines should be taken, based on the patient’s symptoms and medical history.
Not everyone with asthma has wheezing, coughing, chest tightness, breathing difficulties or other symptoms all the time, which can give some patients (or their parents) a false sense of security, VanCleave said. It also can lead to confusion about when asthma medications should be used, she said.
The National Institutes of Health (NIH) recommends that patients who have asthma symptoms more than twice a week during the day or more than twice a month at night need both long-term medications to control asthma and prevent it from getting worse and quick-relief medications, such as an emergency inhaler.
Uncontrolled asthma can lead to a breathing crisis that lands the patient in the hospital. More than 3,000 people die each year from asthma — generally when the patient was not taking medication or not taking it properly, NIH records show.
“I like to think of the long-term control medicines like deodorant for your lungs. If you don’t use your deodorant, you’re going to stink, and nobody can tell until your lungs are really stinky,” VanCleave said. “A lot of kids can ‘get’ that — even preteen boys.”
– Mickey H. Gramig