Do you think it's just a cough? It's actually asthma

Author: He Meijuan, deputy chief physician of Jiangxi Children's Hospital

Reviewer: Li Lan, Chief Physician, Jiangxi Children's Hospital

In pediatric outpatient clinics and wards, children with recurrent coughs lasting more than 4 weeks are often seen. The cough is worse at night or in the early morning, mainly dry cough, aggravated by exercise, without fever, and cannot be relieved by antibiotic treatment. When the doctor diagnosed cough variant asthma after a series of tests, the family members were confused. My child is obviously not wheezing, how can you diagnose him with asthma? So, are the doctors really exaggerating? Of course not.

What is cough variant asthma?

Cough variant asthma is characterized by cough as the only or main symptom, without typical asthma symptoms or signs such as wheezing and shortness of breath. The key points for diagnosis are as follows.

1. Persistent cough for > 4 weeks, usually dry cough, often occurring at night and/or early morning, aggravated by exercise or exposure to cold air, with no clinical signs of infection or ineffective antimicrobial treatment for a long time.

2. Cough symptoms were significantly relieved after diagnostic treatment with bronchodilators.

3. Pulmonary ventilation function is normal and bronchial provocation test indicates airway hyperresponsiveness.

4. Have a history of allergic diseases and a positive family history of allergic diseases. Positive allergen testing can assist in diagnosis.

5. Exclude chronic cough caused by other diseases.

Is cough variant asthma the same as classic asthma?

Cough variant asthma is a special type of asthma. Some patients with cough variant asthma will develop into typical asthma, but this can be prevented through early intervention. Risk factors for cough variant asthma to develop into typical asthma include long course of disease, increased airway responsiveness, and increased eosinophils in induced sputum.

The pathogenesis of cough variant asthma is similar to that of typical asthma, which is caused by the combined effects of immune, genetic and environmental factors, leading to chronic airway inflammation and airway hyperresponsiveness. Immunoglobulin E-mediated allergic reactions are an important cause of cough variant asthma.

How is cough variant asthma treated?

Oral β2 receptor agonists (such as Procaterol, Terbutaline, Salbutamol, etc.) can be used for diagnostic treatment for 1 to 2 weeks. Transdermal β2 receptor agonists (Tulobuterol) are also used. Relief of cough symptoms is helpful for diagnosis. Once the diagnosis is confirmed, long-term standard treatment for asthma is carried out, and inhaled corticosteroids or oral leukotriene receptor antagonists or a combination of the two are selected for treatment, with a course of at least 8 weeks.

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What is the prognosis for cough variant asthma?

Continuous development of cough variant asthma can further lead to lung function damage and small airway dysfunction, and eventually develop into typical asthma. Previous studies have found that 30% to 35.7% of adults with cough variant asthma will develop into typical asthma within 5 years. Therefore, it is necessary to pay attention to the diagnosis and treatment of cough variant asthma. Early accurate diagnosis and timely and effective treatment will help prevent the disease from developing into typical bronchial asthma.

What should parents do?

If your child is diagnosed with cough variant asthma, he or she needs to follow the doctor's advice and receive standardized treatment. You cannot reduce or stop medication on your own. In addition, the following non-drug treatments are also important.

Avoid contact with allergens. Pollen, mites, mold, cat and dog hair, etc. are common inhaled allergens for children, so special attention should be paid. Try not to keep flowers, plants, or pets at home; ventilate the room frequently, and wash bed sheets and blankets frequently; try to avoid children when cleaning to reduce the chances of children coming into contact with allergens; reduce the use of plush toys and carpets; use a dehumidifier during the rainy season or in dark and humid rooms to reduce indoor humidity and reduce the chances of mite reproduction and mold growth. In addition, parents need to carefully observe whether the child has touched or eaten anything before each coughing attack and the pattern of the cough. Try to avoid contact in life. If it is really difficult to judge the allergens by yourself, you can complete the allergen test.

Pay attention to balanced nutrition, regular work and rest schedules, appropriate outdoor exercise and physical training to enhance resistance and improve lung function; when the seasons change or there is a large temperature difference between morning and evening, pay attention to adding or removing clothes in time; avoid places with large flow of people to reduce the risk of cross infection.