Do you think that's just a cough? It could be asthma!

"The symptom of asthma is shortness of breath and difficulty breathing. If it doesn't reach this level, it is not considered asthma?"

Many people believe that the main symptom of asthma is "wheezing". Some patients, especially children, only have a cough as a symptom, but are diagnosed with asthma by doctors. This is an alarmist statement by the doctors and a misdiagnosis.

Rumor Analysis

This statement is not rigorous.

Classic asthma does include symptoms such as wheezing and shortness of breath, but in cough variant asthma, the only symptom is coughing.

May 7th just passed was the 26th World Asthma Day. Taking this opportunity, let’s talk about a common misunderstanding about asthma today.

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In pediatric outpatient clinics and wards, doctors often see children with recurrent coughs that last for more than 4 weeks. The coughs are worse at night or in the early morning, are mainly dry coughs, and are aggravated after exercise. There is no fever, and antibiotics cannot relieve the symptoms. When the doctor diagnosed cough variant asthma after a series of tests, the family members were confused. My child is obviously not wheezing, how can you diagnose him with asthma? So, are the doctors really exaggerating? Of course not.

What is cough variant asthma?

Cough variant asthma is characterized by cough as the only or main symptom , without typical asthma symptoms or signs such as wheezing and shortness of breath. The key points for diagnosis are as follows.

1. Persistent cough for > 4 weeks, usually dry cough, often occurring at night and/or early morning, aggravated by exercise or exposure to cold air, with no clinical signs of infection or ineffective antimicrobial treatment for a long time.

2. Cough symptoms were significantly relieved after diagnostic treatment with bronchodilators.

3. Pulmonary ventilation function is normal and bronchial provocation test indicates airway hyperresponsiveness.

4. Have a history of allergic diseases and a positive family history of allergic diseases. A positive allergen test can assist in diagnosis.

5. Exclude chronic cough caused by other diseases.

Cough variant asthma and

Is it the same as typical asthma?

Cough variant asthma is a special type of asthma. Some patients with cough variant asthma will develop into typical asthma, but this can be prevented through early intervention. Risk factors for cough variant asthma to develop into typical asthma include long course of disease, increased airway responsiveness, and increased eosinophils in induced sputum.

The pathogenesis of cough variant asthma is similar to that of typical asthma, which is caused by the combined effects of immune, genetic and environmental factors, leading to chronic airway inflammation and airway hyperresponsiveness. Immunoglobulin E-mediated allergic reactions are an important cause of cough variant asthma.

How is cough variant asthma treated?

Oral β2 receptor agonists (such as Procaterol, Terbutaline, Salbutamol, etc.) can be used for diagnostic treatment for 1 to 2 weeks. Transdermal β2 receptor agonists (Tulobuterol) are also used. Relief of cough symptoms is helpful for diagnosis. Once the diagnosis is confirmed, long-term standard treatment for asthma is carried out, and inhaled glucocorticoids or oral leukotriene receptor antagonists or a combination of the two are selected for treatment, with a course of at least 8 weeks.

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What is the prognosis for cough variant asthma?

Some people may think that since there are no typical symptoms of asthma, it seems okay to just cough. This idea is wrong. Cough variant asthma should not be underestimated and should be treated in a timely manner.

This is because persistent cough variant asthma can further lead to lung function damage and small airway dysfunction, and eventually develop into typical asthma. Previous studies have found that 30% to 35.7% of adults with cough variant asthma will develop into typical asthma within 5 years. If children with cough variant asthma are not intervened, there is a high probability that they will develop into typical asthma.

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Therefore, it is necessary to pay attention to the diagnosis and treatment of cough variant asthma. Early accurate diagnosis and timely and effective treatment will help prevent the disease from developing into typical bronchial asthma.

What should parents do?

If your child is diagnosed with cough variant asthma, he or she needs to follow the doctor's advice and receive standardized treatment. You cannot reduce or stop medication on your own. In addition, the following non-drug treatments are also important (adult patients can also refer to this).

Avoid contact with allergens. Pollen, mites, mold, cat and dog hair are common inhaled allergens for children, so pay special attention. Try not to keep flowers, plants, or pets at home.

Ventilate the room frequently and change and wash bed sheets frequently.

Try to stay away from children when cleaning to reduce their chances of being exposed to allergens.

Reduce the use of stuffed toys and carpets.

During the rainy season or in dark and humid rooms, you can use a dehumidifier to reduce indoor humidity and reduce the chances of mites breeding and mold growth. In addition, parents need to carefully observe whether their children have touched or eaten anything before each coughing attack and the pattern of coughing. Try to avoid contact in life. If it is really difficult to judge the allergens by yourself, you can complete the allergen test.

Pay attention to balanced nutrition, regular work and rest schedules, appropriate outdoor exercise and physical training to enhance resistance and improve lung function; when the seasons change or there is a large temperature difference between morning and evening, pay attention to adding or removing clothes in time; avoid places with large flow of people to reduce the risk of cross infection.

Looking in the mirror of rumors

In fact, it is not just asthma. The diagnosis of many diseases requires professional knowledge and examinations. We must not just search for information on the Internet and "diagnose" ourselves based on our symptoms. Doing so may miss the opportunity for treatment and cause a minor illness to develop into a major one. On the other hand, it may make us resist the doctor's diagnosis, and we may not strictly follow the doctor's orders for medication and treatment, which will greatly reduce the treatment effect.

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Author: He Meijuan, deputy chief physician, Jiangxi Children's Hospital

Review | Li Lan Chief Physician, Jiangxi Children's Hospital

Editor: Ding Zong

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