<p>After having walking pneumonia a few years ago my daughter has had a tendency to get a cough after a cold. The pediatrician gave her advair disc and it helped until this last October when she has continued to have this nagging cough. She is on advair inhaler plus claritin and mucinex and still has a cough on and off every day. She has a postnasal drip and very occasional wheezing when she is getting over a cold. At that time she was given a rescue inhaler which did nothing for her at all. She still coughed. </p>
<p>She has had a number of pulmonary function tests while she is coughing and her pulmonary function tests have always been normal. Only one time when she was really sick with a cold and cough did the pulmonary function test show a decrease and she was given albuterol and there was no improvement at all! The doctors were puzzled why she did not improve with albuterol but didn’t say anything more.</p>
<p>Is this NOT asthma and vocal cord dysfunction? How can we tell?</p>
<p>It is weird to me that albuterol rescue inhaler never works for her! Doesn’t that mean it is not asthma??</p>
<p>The only way you can tell if she has vocal cord dysfunction is to have her cords examined through a visual procedure.</p>
<p>D2 is a singer and has had asthma issues. At one point, her pediatric pulmonologist started suggesting vocal cord dysfunction, and based on someone’s suggestion we had her tested. Thankfully we have one of the country’s top three vocal cord experts in the Chicago area. </p>
<p>She showed some very minor vocal cord dysfunction, something he said could be helped with some speech therapy. However, whenever we went back to the pulmonologist and told him she’d been tested, he clarified that he thought she had exercise-induced vocal cord dysfunction (because her asthma symptoms were always exercise related), and said the only way to really diagnose that is to do the test during strenuous exercise. D was not interested in going back to the vocal cord expert for another test, so we have not followed up on it (it’s not a horrible test, but not pleasant). If you PM CoachC via CC, she is an expert in this area (speech therapist) and can direct you to the proper place for follow up.</p>
<p>What teri said. You need to find a VCD specialist and get her tested. It is a very simple procedure; in my D’s case, the doctor made her run up and down several flights of stairs (after testing her lung function and confirming that she was very fit), and then took pictures of her vocal cords with a special camera. There are no medications that can help with VCD; the only known treatment is speech therapy sessions with a therapist trained in this area. The main focus of the therapy is learning to breath properly through breathing exercises intended to relax the vocal cords. Albuterol and Advair are not harmless sugar pills; your D does not need to take them if they are not going to help her.</p>
<p>Yes, my athlete has excercise induced asthma. But, she went throught the Vocal Chord testing, too, just because her pulmonolgist does this with all the ex induced asthmatics, since it is a common mis-diagnosis and you don’t want your kid to have to take the advair unless necessary. For mine it is. Wish it had gone the other way.</p>
<p>Find the best pulmonoligist you can, is my advice. Good luck,</p>
<p>Trust me, it is not a better outcome. Even with speech therapy, VCD is not easy to control, and quite often VCD and exercise-induced asthma co-exist…</p>
<p>The good thing about exercise-induced asthma is that some people can “outgrow” it, especially if there are no other underlying allerigies, and when exercise is the only trigger. I suspect that I had EIB when I was a teenager (wheezing, trouble exhaling, and all the other typical symptoms!), but I discovered that I can now breathe normally even when running longer distances (greater than 10 miles) at a pretty fast (for my age) pace for 2 hours at a time.</p>
<p>Yes, our kids were diagnosed with very mild VCD, as well as mild, intermittent asthma which flares with gastric reflux, allergies and infections. Otherwise, they are fine and only need rescue inhaler a few times/year. I’d suggest your D get a better allergy evaluation, as that is definitely treatable–reduce exposure to allergens and consider allergy shots and meds to help her function better. It can improve how she feels & functions. Gastric reflux can also cause coughing and discomfort (as well as reduce lung function). There are over-the-counter meds that can be taken to see if it makes any difference, such as Prilosec (also available as a generic).</p>
<p>Good luck! These conditions CAN be treated effectively so our kids can live full & active lives.</p>
<p>Does everyone with asthma respond to rescue inhaler? In other words, if a person does not respond at all to rescue inhaler does it automatically mean they DO NOT have asthma?</p>
<p>questbest, one of the reasons a person with asthma may not respond or poorly respond to a rescue inhaler is that they are not using it correctly. Some kids need a special “spacer chamber”:
[Asthma</a> spacer - Wikipedia, the free encyclopedia](<a href=“http://en.wikipedia.org/wiki/Asthma_spacer]Asthma”>Inhaler spacer - Wikipedia)
You need to sit down with your D’s doctors and ask them a lot of questions.</p>
<p>People with asthma ONLY respond to rescue inhalers DURING an asthma attack. If they are having other problems or their asthma is under good control, the rescue inhaler does NOTHING (other than possibly cause side effects). I, H, S & D all have asthma that is generally under good control & have had it nearly all our lives, as confirmed by countless tests. We ONLY respond to rescue inhalers as stated above.</p>
<p>Actually, my docs (several of whom have helped develop the medications for asthma & other breathing conditions) say that ALL medications that can be taken with spacers SHOULD be taken with spacers. Most insurers subsidize the cost of spacers that range in price from $30-$50; docs can write the Rx & most are available at the pharmacy.</p>
<p>I would strongly recommend you purchase “One Minute Asthma,” which is a small and easy-to-read book that provides good, current info about asthma.</p>
<p>As stated above, some of the other problems are listed in my prior posts. Another issue, that should be considered for breathlessness, especially in older patients is possible heart problems. There are also other conditions that cause breathlessness, but these are the more common causes.</p>
<p>questbest, there is a little known and under-diagnosed disorder called “cough variant asthma.” So to answer your question: if a person does not respond at all to rescue inhaler it does NOT automatically mean they DO NOT have asthma.</p>
<p>The triggers for “cough variant asthma” vary. But one common trigger is the common cold. Typically, patients take weeks get over a persistent cough. Inhalers do nothing. One treatment is Neophylline, a bronchodilator. Neophylline is an older treatment. Many physicians do not even think of it. But it works. Another medication, theophylline, is also effective but can cause insomnia.</p>
<p>It can take years to diagnose “cough variant asthma.”</p>
<p>^^HIMom, your statements about rescue inhalers working only during an asthma attack not completely correct: for people with EIB, a “rescue” inhaler is prescribed slightly differently (e.g., “two puffs of albuterol inhaler 20 minutes prior to exercise”).</p>
<p>OK, you’re right, BB, but for most of us, even if we have asthma but are showing no signs, the rescue inhaler does exactly NOTHING. Cough variant asthma is indeed frequently overlooked and often under-treated. EIB is different and pre-treatment with the appropriate inhaler works well (Intal sometimes works better that albuterol). Heck, many of the gold medal olympic athletes are EIB asthmatics.</p>
<p>Bunsen Burner, I hadn’t thought about that with the vocal chord issue. I know at the time I was "hoping’ it was asthma, just because the idea of watching her play while “relearning” how to breathe was terrifying to me. She is the kind of kid who runs as hard as she can until she literally passes out. (I think we are lucky she didn’t die.) Later, though, once I was no longer in a state of complete panic every time she took a deep breathe while playing, I thought it would be “nice” not to have to use the steroids. :rolleyes: typical. First I was grateful, then I found the problem.</p>
<p>Quest-- You really need to talk to a pulminologist. If they are not responding to the albuteral, you have to find the “right” solution. Good luck. It sounds challenging.</p>
<p>Depending on how much of an issue it is, one potential option is to consider having your child evaluated at National Jewish. They have very good docs who work together and are able to follow up with your home docs. I, H, and both our kids have been evaluated there. They have good pulmos & allergists, as well as speech therapists, respiratory therapists and others. They were covered by our BCBS PPO plan, so we paid for travel/lodging & the co-pay as if we were seen by local docs that were participating & preferred. Depending on where you live, there are other places that also are great at working with kids who have respiratory issues.</p>
<p>Our daughter’s pediatric pulmonologist has nothing but the highest recommendations for National Jewish. If he were not so highly regarded, I might have pursued that, but he goes out to National Jewish often for continuing ed, consultation, etc. Whenever he gives us news of recent studies, the info always comes out of National Jewish.</p>
<p>Teri and HI mom, I heard the same thing. National Jewish is the world leader in research and treament of pulmonary disorders, according to my D’s VCD and asthma doctors, who also visit it often.</p>
<p>Next month will be my 5th visit there. They are especially good at difficult/baffling cases, but can’t provide the on-going care your docs do (tho mine has been excellent at keeping in touch with me & my docs over the past 11 years, since my initial visit there). </p>
<p>They are the #1 respiratory hospital in the US for many, many years in a row. One of the things I really like about them is that they do a lot of patient education in videos, free training while you’re there as well as the attitude of teamwork and helpfulness throughout most of the personnel there. One thing that I also like a great deal is that the docs there ALL see patients in the clinic and most also do research. This makes them more grounded in both research and clinical practice than a lot of other places and they keep up on all the latest info (many do research for a wide range of places–pharmaceutical, NIH and others).</p>
<p>That said, when our kids were there for a week-long day program evaluation there, they unfortunately didn’t have a “magic bullet” to figure out several of our kids who had complicated and confusing symptoms, though they did their best and ruled out quite a few things. Like everywhere else, some of the docs & staff are better than others. They do have many of the best in the field worldwide, and I am very fortunate to have one of them on my medical team.</p>
<p>questbest - it’s in Denver, and I don’t know about waiting for appointments since we never pursued it. My bet is that there are so many physicians that the wait shouldn’t be too long. There’s probably a lot of work involved collecting and getting all your records sent to them, pre-registering, etc., … the same kind of thing you’d encounter at any major teaching hospital/medical center.</p>
<p>When I have called, I was generally able to get an appointment within a month or so. Much depends on what you want to have done and how long you are planning to stay there. They also try to match the MD to your insurance (I only wanted docs who are participating & preferred).</p>
<p>Yes, you do need to bring all your medical records, including images of your x-rays & CT scans. If you go during the summer, there are lots of kids being evaluated there, but it is in some ways kind of nice for the kids to see other kids there. If your kid is being evaluated there, you & your kid can stay at lodging that is very reasonably priced (on a space available basis) and provides some meals in a community setting (we never stayed there). We stayed at the Hampton Inn at Cherry Creek & got the National Jewish rate, which was about $70/night or so.</p>
<p>[#1</a> Respiratory Hospital in the U.S. - National Jewish Health](<a href=“http://www.nationaljewish.org%5D#1”>http://www.nationaljewish.org) has more info about how to get an appointment, lodging and travel options and more. They also have general info about various health conditions, including symptoms and treatment. You can also pm me if you want more info.</p>