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Help! Persistent cough in teen. No answers from docs.


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My 17 y/o started with a cough after Thanksgiving. It wasn't terrible, just persistent. Would wax and wane, but hang on. Saw the doc after a couple of weeks, and he decided it "could be a developing sinus infection". Though I saw no indicators of this, and this child has never had one, I took his advice and we did a Z pack. Improved a bit, but persisted. Called doc, whose office called back leaving a message that "these things can hang on" and I should be patient.

Went to a second doctor when it had not abated by mid-January. Again, not terrible, just chronic. Doc diagnosed pertussis and prescribed another antibiotic. (Son is up to date on all vaccines, but I know pertussis can arise anyway. No saliva test done.) 10 days of antibiotics later, no change. Called doc's office. Said could be a while before it goes away, see pulmonary specialist if I feel the need. Chest x-ray clear.

So....cough still hanging on. Called pulmonary office, they can't see him for nearly a month, and did not understand why I had been directed to them with a clear x-ray. He has some allergies, but the only really reactive one is cats, and he is not exposed to them more than twice a year. Circles under eyes, though could be free sleep disruption due to cough.

At my wit's end. I need to find some relief for this poor guy, but don't know where else to look!! Any suggestions greatly appreciated.

(Sorry so long!!)

Edited to Add: He does not smoke or use drugs of any kind. I know this for certain.

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interesting they didn't offer up any asthma medicines. When my dd was 4 and had a persistent cough they did the albuterol and it cleared up. Later on my son had the same issue after an illness and was given asthma medicine and it cleared up. This winter we were all very sick with long cough and sure enough all of us did the albuterol and that is what finally cleared us up. I believe we only did a few days of it and the cough disappeared! My dh doesn't seem to have any cough issues but my kids and myself do and now almost every winter after an illness we get a cough that won't go away. A few days of the medicine and it's gone. Something worth asking about.

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Thanks for the ideas. He has a history of susceptibility to pneumonia, and had asthma in middle school. It would present with wheezing after exercise, and he used an inhaler for about two years, though only needed it a few times per year. We keep an air purifier in his room, and he has not had any problems since, but it certainly seems to be a good avenue to pursue.

 

So...what kind of doc do I call now to look into that possibility??

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With that description, I'd suspect pertussis too. It is a really common infection in young adults and adults, whose childhood vaccine-acquired immunity has worn off.

 

Here's the thing about pertussis: Antibiotics don't improve symptoms unless they're given before the coughing starts in earnest. Once the coughing starts, the pertussis toxin-mediated damage has already occurred, so there's not much that can be done. The purpose of prescribing antibiotics is to keep you from giving it to other people. (I'm amazed that so many doctors aren't aware of this!)

 

Pertussis-related coughing normally lasts 2 weeks to 2 months, but it can be longer. It can also "reactivate" for up to a year or more whenever another upper respiratory infection is caught. Sips of water and/or small amounts of honey might help with the coughing.

 

On the bright side, naturally-acquired immunity to pertussis is believed to last much longer than vaccine-acquired immunity.

 

In your shoes I'd keep the pulmonology appointment. It wouldn't hurt to rule out asthma, as a chronic cough can be an asthma symptom. Think about vitamin D too. My dad had chronic reactive airways for YEARS until he started supplementing vitamin D for other reasons. I know the Vitamin D Council website has some info about benefits of vitamin D supplementation for asthmatics.

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My daughter had this same kind of cough last year - Nov. - May. I am surprised your doctor diagnosed pertussis without doing a test - did he/she do any tests for pertussis? Ours did a blood test that turned out to be negative. Can you describe the cough?

 

Anyway, we ended up at a pulmonologist and he diagnosed asthma after dd failed a metacholine stress test. She was put on an inhaler and the cough eventually went away. The doctor said it was cold-air-induced asthma - no allergies, no infections. I'm surprised your pulmonary doctor said he wondered why she was referred w/ a clear chest x-ray. My dd had a clear chest x-ray too, but she still was seen and the doctor didn't seem at all surprised that she was referred to him.

 

My oldest son has asthma, too, and one time an ER doctor suggested he take an acid reducer, Zantac. She knew it sounded odd but had several patients that found it worked for them, so he tried it and it worked. Perhaps you could try that.

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With that description, I'd suspect pertussis too. It is a really common infection in young adults and adults, whose childhood vaccine-acquired immunity has worn off.

 

Here's the thing about pertussis: Antibiotics don't improve symptoms unless they're given before the coughing starts in earnest. Once the coughing starts, the pertussis toxin-mediated damage has already occurred, so there's not much that can be done. The purpose of prescribing antibiotics is to keep you from giving it to other people. (I'm amazed that so many doctors aren't aware of this!)

 

Pertussis-related coughing normally lasts 2 weeks to 2 months, but it can be longer. It can also "reactivate" for up to a year or more whenever another upper respiratory infection is caught. Sips of water and/or small amounts of honey might help with the coughing.

 

 

 

:iagree: antibiotics for pertussis would not do anything to help him at this point.

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IN the paper this past weekend we were reading about a long lasting cough. The reasoning was that because we had such a mild winter there is an airborne bacteria that is giving everyone this long lasting cough. We've had one since Christmas, and the article said many have had it since Nov. I'll try and find it.

 

here

Douglas Borkowski, the medical director of Doctors Express in Paramus, a franchise of urgent care centers, was quoted in the article as saying, "We're seeing a lot more bacterial infections and upper respiratory infections and less of the flu."

 

 

And to make matters worse, the warmer than usual weather has kicked off the allergy season earlier than usual too, ensuring that we'll be popping antihistamines like Zyrtec, Allegra and Claritin along with the usual antibiotic therapies.

Edited by justamouse
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I am putting in another call to the pulmonologist with specific questions related to the information you have all so kindly given me. Hopefully, it will speed things up and we can rule in or out asthma.

He does have GERD, but has been on Prevacid for two years with great success. I will mention that to the doc also.

Neither doc tested for the pertussis, and the doc who diagnosed it said he had seen quite a bit of it in teens lately. I also found several mentions of pertussis occurring in our area in teens and pre-teens in larger numbers than previous years.

 

Thank you all for giving me some clarity. I think I am so frustrated with the doctors' lack of concern/interest that I was not thinking it through.

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My son seemed to have a persistent cough right after a cold the last 3 winters. However, after some research, I decided to start him on some natural allergy medicine for indoor allergens like house dust, dust mite, mold and yeast and it stopped his cough after 3 days. Before he was coughing so much everyday that I knew either he has some sort of asthma (he might still have) or that he is allergy to something in the house. Now, he is taking the same natural medicine for dust etc and another natural medicine for tree pollen which is already out there at this time. This combination has worked wonders for him.

 

Could it be your son is allergy to something?

 

Julia

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My son seemed to have a persistent cough right after a cold the last 3 winters. However, after some research, I decided to start him on some natural allergy medicine for indoor allergens like house dust, dust mite, mold and yeast and it stopped his cough after 3 days. Before he was coughing so much everyday that I knew either he has some sort of asthma (he might still have) or that he is allergy to something in the house. Now, he is taking the same natural medicine for dust etc and another natural medicine for tree pollen which is already out there at this time. This combination has worked wonders for him.

 

Could it be your son is allergy to something?

 

Julia

 

Could you please share specifics on what your child is taking? :D DS suffers from allergies and asthma. I have tried a variety of natural products with mixed results. I would love to have some ideas for other things to try. The local health food store offers so much, I get over whelmed. I feel the same way when I research online.

 

To OP: does your son have any post nasal drip? This is causing a long lasting cough in my other DS.

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Neither doc tested for the pertussis, and the doc who diagnosed it said he had seen quite a bit of it in teens lately.

Testing is not very reliable. False negatives are common, and it is more or less useless if symptoms started more than 2-3 weeks prior to testing. Our ped practice only tests children admitted to the hospital.

 

I also found several mentions of pertussis occurring in our area in teens and pre-teens in larger numbers than previous years.

Pertussis is not at all rare in young adults and adults. While it does sound like there are a lot of pockets of infection around the country, I suspect a lot of it is increased awareness. For years it has been reported that a long-lasting cough in adults is very likely to be pertussis, but many doctors were unwilling to believe an adult patient might have a "pediatric" illness. However, now that the booster has been approved for adults, non-pediatric infections are in the spotlight.

Edited by jplain
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Persistant cough like that with clear xray I would assume asthma. I was Dx with virus induced asthma a few years ago If I get a chest cold or other lung related virus I have residual coughing and need an inhaler. This last year exercise induced asthma was added to the list. I get minimal wheezing, and can usually catch my breath but the coughing was bad. I would cough all night and get very little sleep, having an inhaler to use as needed really helped.

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