Treating Asthma? Especially Cough Variant Asthma

[JumpyTheFrog]

We think that our DS with dust mite and mold allergies might have cough variant asthma. We suspected silent reflux recently and had him start taking Pepcid AC. It is helping, but then one of you suggested it might have an antihistamine effect, and sure enough from what I read, it looks like it does. 

DS actually has an inhaler he was prescribed last year by his PCP. We hadn't used it because the allergy treatment and Singulair seemed to work well enough. Then he needed to go off Singulair because it was making him crazy. We finally had allergy testing done last summer and treating the dust mite allergies plus oral and nasal antihistamines seemed to work well enough. The allergist did not diagnose him at the time with asthma.

DS's allergies have been really bad the last month, so we scheduled another allergy appointment for next week. On Tuesday we decided to have him try the inhaler before gymnastics, just to see if it helped. He didn't really have the giant coughing fits that he usually has (and that we thought were from the chalk making allergies worse). He was able to land some tumbling skills he almost never does. He's having another good practice today, so I think the inhaler is helping.

So does this sound like cough variant asthma? (He never wheezes.) It sounds like inhalers don't help people without asthma.

We also notice he often coughs more after eating. That's what made us suspect food allergies or silent reflux. He was tested for some foods last summer, but I have a few other foods that I wonder about and want to have tested. DH thinks that eating in general making people have some sinus congestion. That doesn't sound healthy to me though.

Obviously I will ask the doctor about this, but does using the inhaler more regularly outside of sports help athletes do better at practice?

[Laura Corin]

For my eldest,  running an air purifier in the bedroom cured cough asthma.

Edited March 27, 2021 by Laura Corin

[JumpyTheFrog]

16 minutes ago, Laura Corin said:

For my eldest,  running an air purifier in the bedroom cured cough asthma.

We have one. I think it helps some. We plan to rip out the carpeting and replace it with hardwood soon. Sitting on carpet or upholstered furniture makes him sniffly, often within five minutes.

[MEmama]

45 minutes ago, JumpyTheFrog said:

 

So does this sound like cough variant asthma? (He never wheezes.) It sounds like inhalers don't help people without asthma.

 

Obviously I will ask the doctor about this, but does using the inhaler more regularly outside of sports help athletes do better at practice?

Quite possibly. DS didn’t wheeze that he or we ever knew of, but the doctor who finally diagnosed him said he sounded terrible. He had struggled for years but it took the right asthma savvy doctor to figure it out.

Yes, using an inhaler regularly is an essential part of many asthma plans for athletes. My DS (varsity runner) has to use two types—one twice a day regardless of activity, and another before/during exercise. Once he had the proper asthma plan, the improvement came quickly. He used suffer from bronchitis and spells where he would cough so badly he would throw up ( even when not exercising), and he hasn’t a single episode like that since.

He runs an air purifier in his room, but it’s definitely not a cure all for him. He absolutely relies on his medication. 

Edited March 27, 2021 by MEmama

[PeterPan]

I cough with my asthma, but I will say that sometimes my lungs are tight (what the doctor and nurse practitioner call wheezing) before I realize it. So wheezing is not only the dramatic stuff you hear, but it's subtle stuff they hear with a stethoscope. I had that happen twice over the last few months, where I thought I was fine and my doctor and then the NP before I went in for hyperbaric both said nope you have a little wheezing in one lung. It wasn't like a super ton, but it was there.

Did they get you a spacer for his inhaler? Love the spacer. 

It does sound like he's got some allergy issues to get sorted out. I need to have my lungs extra good to do this HBOT, so I've been taking an allergy pill each night to make sure I'm good for the next day's treatment. If your asthma is at all acting up and you get in there, the expansion/contraction that happens with the changing pressures makes it worse and is REALLY obvious, oh my. That wheezing involves pockets of mucous (liquid), so the liquid changes volume. You can actually burst parts in your lung, etc. if you're in the HBOT and it expands. 

So sure, assume it's asthma, assume allergies are the issue, and see what you can do. Sounds like you're going to be doing testing and meds. I used to have food reactions and don't now. (nutritionist, rebuild the gut) Turmeric helped me dramatically to get down that inflammation and get off my increasing list of treatments. Hygiene is a huge piece. I got a Roomba and need to run it in my bedroom religiously. Yes, the carpet needs to go. Carpet is so nasty with autism. I remember going to this one hotel, which I assumed was clean, and I lay down on the floor to do some exercises and immediately started having an asthma attack, no joke. And it was a low pile commercial berber type stuff that would clean easily! So hardwood/solid flooring, fluff/wash the bedding, no animals, all the usual recommendations. 

Anxiety can make mine worse. (just saying) And also there's a really good book Running on Air that helped me become more breath aware. I was having problems both on the in (airway constriction, I forget the name) and on the out (asthma). But breath awareness in his gymnastics, being really intentional about how/when he's breathing, might also help.

Does he have a peak flow meter? Might be able to catch some things before they get so problematic. They're under $20 and easy to pack in a gym bag. He can make data before and after his workouts and tell pretty quickly if his asthma is flaring up. For me, and this is just me, it's not just the absolute number but the *variability* that indicates the lack of control. So if my lungs are in a good place, my numbers with even that cheap meter are very consistent, with a low range. But if my lungs are acting up, I start to get wider spreads in the output, which is my sign that I need to get it back under control. Your absolute numbers are dependent on YOU, not a chart or table. I happen to have a peak flow that is crazy high for whatever reason. A few weeks ago my number was around 480, and now with the HBOT (where I've been working on expanding my breath) my peak flow is up at 520. That's relatively high for a woman of my age and stature (5'5").

When I was having serious problems with my breathing, I think my peak flow was around 430 and on some really bad days went down below 380. We'd have to check my data or old board posts and see. It was never ever near the numbers that the "charts" say are even normal for my age and stature. I went into the pulmonologist literally apologizing, saying I knew something was wrong but my numbers were fine by the charts, lol. 

So the numbers are specific to you and relative to you and your physical fitness and what you do and whatever. But if he starts making data with a peak flow meter, that too will help him become more breath aware to track the subtle symptoms of what is happening and when to improve his treatment. Once I made data for a few weeks, I didn't have to keep doing it. Now I just keep the peak flow meter around as a check. 

https://www.amazon.com/Quest-AsthmaMD-Lung-Performance-Meter/dp/B00B9AOKP6/ref=sr_1_5?dchild=1&keywords=peak+flow+meter+asthma&qid=1616859589&sr=8-5  This looks like the updated version of my meter. Nothing fancy but good enough.

[PeterPan]

1 hour ago, JumpyTheFrog said:

does using the inhaler more regularly outside of sports help athletes do better at practice?

You'd like to get his overall level of inflammation and exposure to stuff he's reacting to down so you're not needing this. If he's needing it frequently, rather than as a rescue or just for sports, they're likely to change the inhaler he's using. Once I started in that cycle that was when I was like whoa I need more options. Hygiene, allergy control, anything to reduce inflammation, etc. 

Turmeric has been amazing for me. I take it 3-4 times a day. I use a vitamin shoppe brand that has a standardized potency.

So yes, you're wanting to talk to his doctor and you're looking for referrals.

Edited March 27, 2021 by PeterPan

[Tanaqui]

Honestly, I think you should speak to a pulmonologist about this. You don't seem to have a clear game plan for handling his asthma - you're not sure it IS asthma, though it certainly sounds like it to me! - and you're winging it. Rather than going back to the GP about this, just go to a specialist and get it done.

(Also - even if you don't intend to take my advice above, research whatever inhaler you use, and if it requires a spacer, get a spacer. You can buy them cheap off ebay, and they make the inhaler MUCH more effective.)

[JumpyTheFrog]

We have a spacer and are using it. He has an appointment with the allergist on Monday. I want to get him tested for a few more allergies and for asthma.

[melmichigan]

3 minutes ago, JumpyTheFrog said:

We have a spacer and are using it. He has an appointment with the allergist on Monday. I want to get him tested for a few more allergies and for asthma.

Allergist have their place, but in my experience, start with the pulmonologist.  I've has asthma and allergies my entire life.  I cough. I don't wheeze until I am in crisis.  My pulmonologist got my asthma under very good control, with a detailed plan, then I pursued the allergy aspect.  One is not, IMO, a substitute for the other.

[sbgrace]

15 minutes ago, Tanaqui said:

Honestly, I think you should speak to a pulmonologist about this. You don't seem to have a clear game plan for handling his asthma - you're not sure it IS asthma, though it certainly sounds like it to me! - and you're winging it. Rather than going back to the GP about this, just go to a specialist and get it done.

(Also - even if you don't intend to take my advice above, research whatever inhaler you use, and if it requires a spacer, get a spacer. You can buy them cheap off ebay, and they make the inhaler MUCH more effective.)

I agree that pulmonology is best. Your son doesn't sound well managed. 

Using an inhaler (w/spacer) prior to exercise is normal for asthmatics. Keep doing that. But, when we got my son's asthma under control (allergy control for him), we didn't have to do that anymore. 

4 minutes ago, JumpyTheFrog said:

We have a spacer and are using it. He has an appointment with the allergist on Monday. I want to get him tested for a few more allergies and for asthma.

Remember that food allergy tests have a really high rate of false positives. You only want to treat it like an allergy if it causes symptoms. Environmental allergy tests are much more accurate. 

HEPA filter in the bedroom helped in our old house, allergy friendly bed (wash and dry all bedding on hot weekly) helped, so did getting rid of carpet (and our cats died before we moved, this house has never had a cat...I know that and lack of carpet helped him a lot...we rarely use the HEPA anymore). 

[PeterPan]

The pulmonologist offered the referral to the allergist. So it's not either/or but BOTH.

[SoCal_Bear]

When I am triggered I used to be on a protocol of Advair and Singulair...until I started having mental side effects from Singulair. I'm so sorry that your son went through that. It was scary for me. Now, I do Flonase and Advair as needed. I'm not on Advair unless I start to cough. I hope that you find a protocol that works. I can't be on Allegra, Clartin or Zyrtec either because they trigger mental side effects as well. 

Edited March 28, 2021 by calbear

[Swimmer1112]

My son has cough variant asthma. He takes his inhaler about 20 minutes before swim practice or any hard exercise.  It prevents his coughing fits during exercise. 

Edited March 28, 2021 by Swimmer1112