Cough could be asthma, or nothing to worry about

Cough could be asthma, or nothing to worry about

Dear Dr. Donya,

My name is Jennifer, and I am a mother of 2 boys. My youngest son is now eight months old. Since birth, he has suffered from noisy breathing, especially during his sleep. The noise is like he has a lot of phlegm. Doctors in Jakarta (GPs, and a pediatrician as well), said that it's common for babies of up to two to three months. But my baby had this continually up to four to five months old.

Then a GP told me to pat his back for around 30 minutes every morning in the sunshine. I did that until he was about 7 months. In Medan, another doctor said that my baby had bronchopneumonia.

However, a pediatrician said the noise is caused by narrow nasal passages. When my son grew older, the nasal passages would also grow wider, and the noise would eventually disappear.

Then an oncologist said that he had asthma. However, we doubt it. It's very rare for babies under one year old to have asthma: we suspect he has bronchitis.

My questions are:

How can you tell the difference between asthma and bronchitis?

What are the solutions or what can we do for asthma and bronchitis? -- Jennifer Lewandowski

Dear Jennifer,

Your question is very interesting because your child has had the problem since he was four months old. Coughing, wheezing, troubled breathing or any combinations of these are symptoms of asthma.

Most people identify asthma as just wheezing. The truth is that for a fair number of children who have asthma, a cough is the only symptom. The asthma often goes undiagnosed or is misdiagnosed as bronchitis.

For asthma you look for coughing that recurs and comes in a series. It is recurrent as a coughing episode and then the child is well for a while until the next trigger occurs, such as a cold, at which time the cough then recurs. Asthma-related coughs also typically come in a series of coughs rather than as single coughs.

They are spasmodic and worse at night. If your child's coughing is spasmodic, worse at night and lasts more than a couple of days with a cold, he may have asthma, especially if such coughing occurs with each cold.

Wheezing is a little easier to identify. You'll hear a whistling-like sound when your child exhales. If your infant is coughing, wheezing and short of breath, it's likely he has either asthma or bronchiolitis (a lung infection that usually occurs only once and usually during the first six months of life).

The clue to distinguishing a cough from asthma and a cough from the common cold is that a cough from a cold will mostly not cause you worry. But if the cough occurs with every cold and is spasmodic and worse at night, the cough may well be due to asthma.

Bronchitis is a condition that occurs when the inner walls that line the main air passageways of your lungs (bronchial tubes) become inflamed. Bronchitis often follows a respiratory infection such as a cold.

And just as most people get occasional colds, virtually everyone has bronchitis at least once. Most cases of acute bronchitis disappear within a few days without lasting effects, although coughs may linger three weeks or more. But if you have repeated bouts of bronchitis, see your doctor. You may have a more serious health problem, such as asthma

When your child breathes, you can hear a wheezy, high-pitched noise. Is that normal? No. Is that common? Yes. Episodes of wheezy breathing happen quite often. In fact, between 20 percent and 30 percent of children report having an episode of wheezing at some point in their lives. But that doesn't mean it's OK. As a parent, how do you know when to be concerned?

Asthma is not the only cause of wheezing. Other conditions that can cause episodes of noisy breathing include:

Bronchiolitis. This is a narrowing of the smallest airways in the lungs. The condition results from a virus, commonly the respiratory syncytial virus (RSV).

Aspiration. This condition is caused by inhalation of an object. Younger children especially may choke on large pieces of food, which then become lodged in their airway and cause wheezing.

Nasal obstruction. This occurs when a foreign object perhaps a rock or crayon or a nasal polyp partially obstructs the breathing pathway, causing noisy breathing.

Vocal cord dysfunction. This is abnormal closure of the vocal cords that can cause a wheezing sound, usually on inhaling.

My concern is that your son probably has an obstructed airway. Here are some of the questions that you should answer

Is this your child's first episode of noisy breathing or have there been others? Is your child working harder to breathe than normal? Is your child breathing faster than normal? Is your child experiencing coughing associated with wheezing? Does the wheezing noise occur upon inhaling or upon exhaling?

Does anything seem to make your child's symptoms worse or better? --Dr Donya