Getting rid of an asthma induced cough

[Shellydon]

Every year I have an asthma flare up due to allergies to pollen. When this happens, I cough (and cough and cough and cough).  Medications help a little bit-- I am on Advair inhaled twice a day, Singular, Flonase (twice a day)-- but I still cough.  By 4:00 pm I am coughing nearly constantly and by 7:00 I have to sit most of the time or I cough until I vomit.  I have visited multiple doctors, thus the meds, but I would really like to completely stop coughing.  Anyone BTDT? 

[wapiti]

Are you using your albuterol inhaler for coughing?  Have you considered allergy shots?  Or possibly a lingering, subclinical infection that gets exacerbated by the allergies during pollen season?

 

(I hate advair - gave my ds horrible insomnia)

 

ETA, agreeing with the other posters that a neb can be more effective than the inhaler.  That's not what the docs have said to us, but in my experience with asthma/pneumonia/bronchiolitis and hospitalizations for four of my six kids when they were younger, the neb was always a surer bet compared to the inhaler.  It takes longer so it's less convenient, but always seemed to work a bit better when the going got really rough.  It also seems to help to keep a regular schedule around the clock for albuterol until the cough is long gone.

 

Thinking some more about the big picture, there are levels of the LABAs so maybe a stronger one is the way to go (Advair, Symbicort and Dulera are all LABAs).  Maybe you need to ask around to find a better allergist or see a pulmonologist.

 

(When my ds didn't grow for a year, I started getting nervous about the LABA, as there seems no where to go but up.  We ended up changing allergists, downshifting to Flovent instead of the LABA, and trying a bunch of alternative things in the meantime.  We are in the middle of allergy shots.)

Edited October 21, 2016 by wapiti

[Pippen]

Did they offer you a nebulizer? I do much better during flare-ups with nebulizer solutions instead of inhalers. 

 

It sounds like you might need some different meds. My allergist had to try a few until we found a combination that worked well, which in my case is Albuterol and Pulmincort.

 

Then it was important to learn to start them as the first possible symptoms and then medicate an an ongoing basis until symptoms had completely passed. In fact I medicate preventatively when I get a cold instead of waiting for asthma symptoms. 

[heartlikealion]

My son has a nebulizer. His can be used every 6 hours, 3-4x daily. As others mentioned this may be an alternative to look into.

[Carol in Cal.]

Surprisingly to me, cough medicine does help. I use those maximum strength Mucinex tablets, the extended release ones.  And if my doctor will give me codeine cough medicine, I take that at night. 

[Ottakee]

Likely you need some albuterol either through an inhaler or nebulizer.

 

That said, I finally gave in and took the oral steroids....and within 2 days the cough was gone. I hated to take them but my friend who is a doctor insisted I needed them (my own doctor prescribed but I had tried to avoid taking them).

[happypamama]

Consider Zyrtec or some other allergy medicine too.

 

I take a Zyrtec pretty much year round, and in about April I start a Flonase oral inhaler daily because my allergy is to dust mites, and they are worse in warm weather. I stay on the Flonase until about September or October, although this year, between a hot fall, house construction, pregnancy, and a September cold, I just stopped taking it about a week ago. Without it, I'll need my Albuterol four times a day.

 

Everything I've heard says that if you're using Albuterol more than occasionally, you need something preventative. I would talk to your doctor about a different steroid inhaler.

[Shellydon]

Did they offer you a nebulizer? I do much better during flare-ups with nebulizer solutions instead of inhalers. 

 

It sounds like you might need some different meds. My allergist had to try a few until we found a combination that worked well, which in my case is Albuterol and Pulmincort.

 

Then it was important to learn to start them as the first possible symptoms and then medicate an an ongoing basis until symptoms had completely passed. In fact I medicate preventatively when I get a cold instead of waiting for asthma symptoms. 

 

No, but when I get really sick and tired of coughing all night, I will go to a minor emergency clinic nearby and they always do a nebulizer treatment, which seems to help for a few days.

[Shellydon]

Likely you need some albuterol either through an inhaler or nebulizer.

 

That said, I finally gave in and took the oral steroids....and within 2 days the cough was gone. I hated to take them but my friend who is a doctor insisted I needed them (my own doctor prescribed but I had tried to avoid taking them).

 

I have a albuterol inhaler as well, but find the Advair to work better.  Oral steroids make no difference (which is good, I hate them!).   

 

 

I will plan to hunt down a different allergist tomorrow.  Thanks all!

[wapiti]

I have a albuterol inhaler as well, but find the Advair to work better. 

 

I don't understand - Advair is long-acting steroid, whereas albuterol is short-acting rescue medicine.  You can and should use both, Advair 2x per day always, and albuterol every 4 hours as needed.  If you do the albuterol a little while prior to the Advair, your lungs should be more open to get the Advair in there.

Edited October 21, 2016 by wapiti

[Seasider]

At the risk of you shaking your head and saying, "duh! of course!" I must ask, are you taking other measures to reduce irritants in your environment? Showering in the evening, fresh pillowcases often, bedding washed in 120F+ temps, air filter, that kind of thing?

 

My son had seasonal allergies so bad he took both Zyrtec and singulair; individually neither was strong enough. Nasal corticosteroids keep me from being miserable at certain times of the year but it looks like you are already on Flonase. I have combined it with Mucinex to alleviate the throat tickle.

 

Have you ever tried Allegra? It really dries me up, I don't use it unless I'm desperate because it makes me sleepy, but it might be worth a try. I'm sorry you are having such trouble, that's just miserable.

Edited October 21, 2016 by Seasider

[heartlikealion]

No, but when I get really sick and tired of coughing all night, I will go to a minor emergency clinic nearby and they always do a nebulizer treatment, which seems to help for a few days.

 

I can't imagine a one time treatment being that effective. I highly recommend you seek out a nebulizer machine. Can you get it covered by insurance by any chance? Both my son and grandmother have machines. We have had treatments done at the ER when it was a severe issue and they also gave him a liquid steroid, but in general, we just keep the albuterol sulfate and nebulizer handy. We even travel with it.

[EmmaNZ]

My sn has had lots of issues coughing with his asthma, and is on a cocktail of inhalers at similar profiles to yours. He has found a fair amount of relief taking montelukast tablets at night. It is not a steroid, it works by affecting the function of white blood cells.

[blondeviolin]

Are you sure it's cough-variant asthma and not post-nasal drip irritating your vocal chords?  You might do some research on Vocal Chord Dysfunction.

[G5052]

All good advice. I had the use a nebulizer yesterday because my asthma coughing was waking me up at night. Much better last night. During bad pollen periods, I have to do that about once a week, or more if I'm going to be outside a lot.

 

DH bought the machine last winter online, which was actually cheaper than going through our insurance. Then the co-pays for the little tubes are very reasonable. They come in a box that lasts me quite awhile.

 

My allergy doctor says that coughing is as bad as wheezing in terms of being an indicator of asthma that is not in control. Assuming of course that you aren't sick.

[Pippen]

I have a albuterol inhaler as well, but find the Advair to work better.  Oral steroids make no difference (which is good, I hate them!).   

 

 

I will plan to hunt down a different allergist tomorrow.  Thanks all!

 

If you can't get into a different allergist quickly, a primary care doctor or walk-in clinic should at least be able to change up your meds for the short term. They also might prescribe something for the cough.

 

The right meds are so important. For instance, two of the three meds that you listed--Singulair and Flonase--were totally ineffective for me. But they are highly effective for others, which is why it's important to move on if they aren't working after a reasonable trial period. 

 

I also suggest you add back in the Albuterol and keep it up around the clock as prescribed until the flare-up has passed. Different asthma meds are prescribed together because they work differently. Think of it as the tandem effect--using the Albuterol first will open up the pathways so the Advair and Flonase can be more effective. 

 

https://www.verywell.com/bronchodilator-or-steroid-inhaler-3970974

 

A nebulizer adds another level of effectiveness, as it's more likely to deliver the medication to the target than inhalers..

 

Someone else mentioned Allegra, and I always add Allegra-D when my symptoms flare up. Post nasal drip is a primary trigger for me, so controlling the drainage is critical. 

Edited October 21, 2016 by Pippen

[Plink]

Advair is the only thing that works for my son.

 

Seconding the advice to look into allergy shots.

[wapiti]

My sn has had lots of issues coughing with his asthma, and is on a cocktail of inhalers at similar profiles to yours. He has found a fair amount of relief taking montelukast tablets at night. It is not a steroid, it works by affecting the function of white blood cells.

 

A good thing to try.  I think she's already doing this (Singulair = montelukast)

[ktgrok]

If it's a dry, tickle cough some vicks vapor rub on the chest would help me as a kid. If it's mucus, you need to talk to your doctor about it. Also, humidity helps. 

[Carol in Cal.]

No, but when I get really sick and tired of coughing all night, I will go to a minor emergency clinic nearby and they always do a nebulizer treatment, which seems to help for a few days.

Aren't those amazing?  They are almost like a 'reset button' for me.  An at home nebulizer isn't nearly as effective, I think because they can use much higher dosages in a clinical setting where monitoring is ongoing.

 

I want to second the oral steroids, though.  Those work just about as well as the emergency nebulizer treatments.  They ARE systemic, so you don't want to do them as often, but like the clinical nebulizer, they just plain knock out the inflammation in your lungs completely, again like a 'reset button'.  Plus they knock out all of your other inflammation, too--I had plantar fascitis for years and worked on healing it in lots of ways, but what finally got rid of it was a course of oral steroids for my asthma.  That same one actually deepened my voice--I think that I had had inflammation and / or mucus built up in my throat and air passages for so long that my voice had adjusted to it, and when it left, my voice actually changed for a while. This was a bit disconcerting since I sing in a big chorus, but I adjusted to it pretty quickly.  

[JessReplanted]

I have a albuterol inhaler as well, but find the Advair to work better. Oral steroids make no difference (which is good, I hate them!).

 

 

I will plan to hunt down a different allergist tomorrow. Thanks all!

Advair is a maintenance medicine - an oral steroid. You use it daily to reduce inflammation. You need the albuterol for when your airways are constricted - which coughing is a symptom of.

Cutting out dairy also may help.

[kbutton]

Aren't those amazing?  They are almost like a 'reset button' for me.  An at home nebulizer isn't nearly as effective, I think because they can use much higher dosages in a clinical setting where monitoring is ongoing.

 

 

I believe they also sometimes mix steroids and albuterol together in one treatment.

 

 

OP, I would consider Mucinex, albuterol (nebulized or with a spacer if you can--check your technique as well), and take the abuterol as frequently as possible. If that doesn't help, oral steroids will probably nip it. I seem to need steroids if I have inflammation in my chest, but if it's lots of postnasal drip, then the other stuff works. I tend to use Mucinex without the decongestant if I can. If I need to use a decongestant, I get a 12-hour one to take separately because I often need the cough part longer than the decongestant. In the past I have had good results (and fairly quick) with vitamin C and zinc for inflammation (sounds weird, I know).

 

In the past, I have had very sudden onset allergy symptoms (usually during ragweed) that caused very, very watery discharge and mucous, and it felt like it was raining in my lungs (and out my nose, etc.--just poured out like a faucet for hours). That's just about the worst trigger for my asthma. A decongestant and lots of albuterol helped the most, and getting the allergies under control with antihistamines (claritin and allegra work for me) helped keep it at bay. 

[heartlikealion]

Aren't those amazing?  They are almost like a 'reset button' for me.  An at home nebulizer isn't nearly as effective, I think because they can use much higher dosages in a clinical setting where monitoring is ongoing.

 

I want to second the oral steroids, though.  Those work just about as well as the emergency nebulizer treatments.  They ARE systemic, so you don't want to do them as often, but like the clinical nebulizer, they just plain knock out the inflammation in your lungs completely, again like a 'reset button'.  Plus they knock out all of your other inflammation, too--I had plantar fascitis for years and worked on healing it in lots of ways, but what finally got rid of it was a course of oral steroids for my asthma.  That same one actually deepened my voice--I think that I had had inflammation and / or mucus built up in my throat and air passages for so long that my voice had adjusted to it, and when it left, my voice actually changed for a while. This was a bit disconcerting since I sing in a big chorus, but I adjusted to it pretty quickly.  

 

Hmm, I don't know that I would describe any of ds' in office treatments as some wonderful reset button. It didn't end there. He just had a treatment at the dr's office on Wed. and we've been giving him breathing treatments since. It could be different for children, but I might ask sometime if they do the same dose in office. Granted, maybe you're just talking about visits for seasonal stuff which would be different than our reasons for office visits.

 

All good advice. I had the use a nebulizer yesterday because my asthma coughing was waking me up at night. Much better last night. During bad pollen periods, I have to do that about once a week, or more if I'm going to be outside a lot.

 

DH bought the machine last winter online, which was actually cheaper than going through our insurance. Then the co-pays for the little tubes are very reasonable. They come in a box that lasts me quite awhile.

 

My allergy doctor says that coughing is as bad as wheezing in terms of being an indicator of asthma that is not in control. Assuming of course that you aren't sick.

 

Wait, do you change your tubes a lot? We've had the same one on the whole time. But the hospital and dr's office offered us the mask/tubing set after our in office visits since they cannot reuse them I think. Now we have three tubes. I figure they are like breast pump tubes, which you can periodically clean and air out, but probably don't normally need to replace?

Edited October 22, 2016 by heartlikealion

[Laura Corin]

Having a good quality air cleaner running in Calvin's room cured his cough asthma.  It ran all night, so as he was small and sleeping a lot, about half his day was spent in very clean air.

[sbgrace]

I know you've responded to this, but albuterol is what stops that kind of cough for me--used as a rescue. I do use a spacer with my inhaler, and that or a nebulizer can really improve the results from Albuterol.

 

The maintenance steroids don't stop acute asthma--which is what you're describing.

 

My son takes Singulair and daily zyrtec. I also started pycnogenol with him, and that helps too.

 

He has a nasal anti-histamine he can use. Also, nasal steroids can be very effective with some allergy related asthma.

[ILiveInFlipFlops]

My youngest has a similar problem. Every time she gets any upper respiratory infection, even the mildest one, within a couple of days she'll start "that" cough and I'll know what's coming. After years of experimentation (and multiple rounds of pneumonia :(), a pediatric urgent care doc finally hit on the solution, and it is Flovent. She does two puffs of the 44 mcg inhaler in the morning and at night before bed and that seems to stave off most of the URIs she was getting so frequently. When she does get sick with something, we start immediately with two puffs the 110 mcg Flovent and her albuterol inhaler three times a day, every day until she's out of the danger zone. It's the only thing that works outside of prednisone and the like, and I really don't want a growing kid on those long term.

 

I hope you find whatever works for you!

Edited October 22, 2016 by ILiveInFlipFlops

[NoPlaceLikeHome]

Advair is the only thing that works for my son.

 

Seconding the advice to look into allergy shots.

This may be true to keep a person stable but advair is never used as a rescue medication for acute shortness of breath. Albuterol and some other inhalers are used as rescue medications via inhaler or nebulizer.

 

 

FYI everyone, xopenex now comes in a generic inhaler. I got it for kiddo since he does get tachycardic with albuterol sometimes. 

 

As for OP, have you seen a pulmonologist or is your allergist board certified in both? I would definitely want a neubulizer on hand and even a prescription for short burst of steroids to keep on hand if your doctor lets you.

[kroe1]

Three things cause the majority of chronic cough:

 

1. Asthma

2. Post nasal drip/allergens

3. Reflux

 

Since most have a component of two or more of these, it seems like you should add something for reflux to see if it helps. If it doesn't, then you really haven't lost much. It seems like you have the first two covered on what you have already tried.

[Seasider]

Three things cause the majority of chronic cough:

 

1. Asthma

2. Post nasal drip/allergens

3. Reflux

 

Since most have a component of two or more of these, it seems like you should add something for reflux to see if it helps. If it doesn't, then you really haven't lost much. It seems like you have the first two covered on what you have already tried.

My physician recommended Zantac as both an antihistamine and reflux remedy - he said it's multipurpose with regard to allergies. My reflux and post nasal drip weren't concurrent, so I never tried it, but maybe you would find it helpful, OP.

[Shellydon]

Thanks all!  I've been out of town, so catching up on the posts.  I ran out of advair, so I started up xopenex followed by Flovent.  The Advair definitely works better for me.  Still coughing like crazy, I'll call an allergist tomorrow.

[Spryte]

Seconding the above, but one thing I didn't see mentioned: you take advair? My son has to add Qvar. It's unconventional. But there's something about treating two different molecule sizes that is magic. Huge difference. He takes advair, Qvar, nasonex and albuteril as needed. When things are very bad, we do neb treatments every four hours. He also does a preventive albuterol inhaler 30 mins before exercise.

 

Singulair dos nothing but make him crazy. Aaack!