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Coughing At Night Or When Running? Think Asthma.

The Asthma and Allergy Foundation of America (AAFA) calls May the National Asthma & Allergy Awareness month because this is the peak season for problems. So it seemed fitting to write about asthma and increase awareness.

Asthma is major health concern in America. Did you know (according to the AAFA)

  • 10 people a day die from asthma
  • Asthma affects 24 million Americans
  • 3 million children (younger than 18) have asthma

Asthma is chronic disease that causes the airways in the lungs to be inflamed. The inflammation causes the airways to become narrow. Those narrow airways spell trouble whenever the demands on the lungs are increased.  Those demands, or “triggers,” make it difficult to breathe when a person has asthma.

Common Asthma triggers

  1. Exercise
  2. Viruses/sickness
  3. Cigarette smoke (both first and secondhand)
  4. Pets
  5. Allergens
  6. Cold air/weather
  7. Molds and dust

If you don’t have asthma, it can be hard to understand what having an attack feels like. Imagine running a mile and only being allowed to breathe through a straw. Pretty quick you would feel terrible. Your head would hurt and you’d feel dizzy (from not getting enough oxygen to your brain). You’d be seriously winded, extremely tired, and your chest would be hurting. Even when someone with asthma is not having an attack, it is common to still be symptomatic.

Asthma Signs and Symptoms

  1. Cough (especially worse at night and first thing in the morning)
  2. Cough with exercise
  3. Wheezing
  4. Shortness of breath
  5. Chest tightness

What Causes Asthma?

The short answer is we don’t exactly know. The longer answer is that science has shown a number of different contributing factors.

  1. There’s a lot of different science to show that early and frequent exposure to certain common allergens and infections decreases the risk of developing asthma. For example, having a pet early in life can decrease the risk of developing asthma, but later the pet can act as a trigger. Coming from a large family or living on a farm is also protective against asthma. Early use of antibiotics in life is also linked to asthma (yet another reason to judiciously use antibiotics). Viruses can both decrease and increase the risk. For example, early exposure to respiratory syncytial virus (RSV) increases the risk.
  2. There is a strong genetic component to developing asthma. There are many specific genes that have been linked to development of asthma. Families that are “atopic,” that is, those with eczema, allergies, and asthma, are also at increased risk. So while one condition (e.g., eczema) doesn’t lead to the other (e.g., asthma), having one, increases the risk of developing another. This phenomenon is often referred to as the “atopic march.”

Ashtma Treatment

There is no cure for asthma. You may have heard of kids “outgrowing asthma.” While not exactly true, the concept is that the lungs continue to grow and develop in the first 6-8 years of life. Many kids, who had trouble when they were toddlers, will get better as their lungs mature. Treatment generally consists of using medications (commonly inhalers) to modify symptoms and avoiding triggers. Inhalers are divided into 2 groups:

  1. Controller inhalers. These medications are used daily to prevent the asthma attack. Generally, these are inhaled steroids.
  2. Rescue inhalers. These medications are used on an as needed basis to deal with symptoms when the asthma has flared.

You will work with your child’s pediatrician to help determine the severity of your child’s asthma. The severity will determine what and how often you’ll be giving your child medication. (As an aside, prep yourself. The medications can be really expensive and unfortunately, there aren’t a lot of generic drugs available).

If you managed to read the entire article, here’s the comical reward for your efforts. Whenever I write an article, I often double check facts (especially if I quote a statistic). I discovered this interesting historical note about asthma. In the 1930s-1950s, asthma was considered one of the “holy seven” psychosomatic illnesses. Asthma was considered psychological and was consequently often treated with psychoanalysis and other talking cures. The “wheeze” (which is really from a constricted/tight airway) was thought to be a suppressed cry of a child for its mother. The treatment of depression was especially important for people with asthma. Isn’t that a riot? If your doctor prescribes Prozac to your child who is having an asthma attack, your doc may be a little too old school. Throw that little historical nugget out at your next dinner party.

Respiratory Bug (Coronavirus) Is Going Around

If you’re feeling like you’ve simply had enough of the miserable cough and cold bugs this season, you are in good company. I feel like it’s been a particularly bad season this year, and just when I think it is starting to let up, we’ve got a new bug on the forefront: Coronavirus.

Coronavirus is a common virus that causes mild-to-moderate upper respiratory illness. To date, there are 5 different Coronavirus strains that make people sick (that I’m aware of). The infamous SARS outbreak of 2003 and the Middle East Respiratory Syndrome (MERS) of 2012 are both Coronavirus strains. Fear not, the strain that we are seeing in our community right now though is not SARS or MERS. Random trivia, the virus is called Coronavirus because the little virions look like spikes on a crown under the microscope (take that piece of trivia to your next dinner party).

Coronavirus top 10 quick facts:

  1. Most people will get infected at some point in their life with Coronavirus.
  2. Young children are far more likely to get it.
  3. You can get infected over and over with it (there isn’t life-long immunity with it).
  4. Symptoms include: runny nose, cough, sore throat, and fever. (Kind of sounds like every other bug right?)
  5. It’s usually a fall and winter bug, which makes the outbreak in our community this time of year even more interesting.
  6. It’s easily spread from person-to-person through the air by coughing and sneezing, or via direct contact, like touching or shaking hands.
  7. There are no vaccines against it.
  8. Reduce transmission by frequently washing hands, staying away from sick people, and not touching your face.
  9. There is no cure. Treatment is all symptomatic (i.e., decongestants, humidifiers, fever medications, rest, fluids) until your body conquers the bug on its own.
  10. The diagnosis is made by a clinical test (swabs up the nose are easiest, but blood tests also exist). Most doctors don’t bother to test, since there isn’t a specific treatment anyhow and the test is costly, takes time, and isn’t comfortable.

Hopefully, you’ll manage to avoid this one, but in case you don’t, at least you’ll know what you’re up against. Stay healthy!

Decoding Cough And Cold Medications

I was recently at the store and went to the cough and cold aisle. There was a mom standing there with an obviously sick kid in the cart. She was just staring at all the meds and looked like she was about to cry. I generally try not to offer friendly, unsolicited advice to strangers (strange, people usually don’t like it), but I decided to speak up in this case. When I told her I was a pediatrician and asked what her child’s symptoms were, she nearly fell into my arms with relief for the help. So I thought I’d pass on a few tips

Age: (Limitations are based on safety data)

  1. Under 2 months: See your doctor.
  2. 2-6 months: Very limited options. Try Tylenol (generic is Acetaminophen), saline nose drops (to loosen and suck out boogers), and a cool mist humidifier.
  3. 6-12 months: Still limited options. All the above, but can add Motrin (generic is ibuprofen).
  4. 1-4 years: All the above, but can add honey. Give it plain or mix it into a tea, etc. Honey has been shown to help some with cough.
  5. 4-6 years: All the above, with caution using cough and cold medications. FDA says yes on cough and cold meds over 4 years. AAP (The American Academy of Pediatrics) says over 6 years before using cough and cold meds.
  6. 6+ years: All the above, plus cough and cold medications.

Decoding the medications:

  1. Dextromethorphan (DXM or DM): Used as a cough suppressant. Commonly found in Delsym, Robitussin, Dimetapp, Coricidin, Mucinex DM, etc. If your kid has a cough, find a med with this in it.
  2. Pseudoephedrine (PSE): Used as a decongestant (helps with the runny or stuffy nose). Found in Sudafed, Tylenol Cold, Robitussin, Benedryl Cold, etc. It may be more effective than phenylephrine, but it is regulated closer (it is used in the manufacture of methamphetamines). As an aside, the FDA warns against using long-acting or extended release preparations of pseudoephedrine to kids under age 12.
  3. Phenylephrine (PE): Used as a decongestant (again helps with the runny or stuffy nose). Meds generally have pseudoephedrine or phenylephrine, but not both. Found in Sudafed PE, Triaminic, etc. The data is hit and miss on the effectiveness of phenylephrine.
  4. Guaifenesin (GG): Used as an expectorant (helps loosen and bring up the phlegm). Found in Mucinex, Duratuss, and Tylenol Complete Cold, Cough & Flu. Medically, I am not sure why cough suppressants and expectorants are put together in combination medications. It is counter intuitive (one stops the cough while the other is trying to bring the stuff up). For that reason, I never buy combination medications with Dextromethorphan and Guaifenesin together. (Note: This is my personal opinion here).
  5. Acetaminophen (APAP): Used as a fever reducer and pain reliever. Trade name Tylenol. Either Acetaminophen or Ibuprofen is in almost all combination cold medications. Advantage over Ibuprofen is that Acetaminophen is easier on the gut and fewer side effects, but shorter acting (4 hrs.).
  6. Ibuprofen (IBU): Used as a fever reducer and pain reliever. Trade name Motrin. Either Ibuprofen or Acetaminophen is in almost all combination cold medications. Advantage over Acetaminophen is that Ibuprofen has an anti-inflammatory effect and lasts longer (6 hrs.), but is harder on the gut.
  7. Chlorpheniramine maleate (CPM): Used as an antihistamine (helps dry up secretions, usually associated with allergies). There isn’t much of a place for allergy meds in colds, unless there is an allergic component playing into the symptoms. Antihistamines are often added to the “nighttime” medication versions, because of the sedating side effects of antihistamines.
  8. Diphenhydramine (DPH): Used as an antihistamine. Active ingredient in Benedryl (see explanation for #7).
  9. Doxylamine Succinate: Used as an antihistamine (see explanation #7).

Wow, that is quite a list. It’s not exhaustive, but should cover 90% of the meds out there. If you got lost, here’s the very short of it: Choose the medications with the smallest amount of ingredients to cover the symptoms. Never give your kid a medication that he doesn’t need. If your child has a cough, choose something with just dextromethorphan (like Delsym). If there is a stuffy nose only, choose just pseudoephedrine (like Sudafed). If you choose single-drug meds, you can add Acetaminophen (Tylenol) or Ibuprofen (Motrin) in addition for fever/pain relief. If the med you choose has Acetaminophen or Ibuprofen, don’t give either in addition or you’ll risk overdosing. Generally limit the medications with antihistamines to nighttime, or shy away altogether. Always dose children’s medication based on weight, not age. Hopefully this helps you as you navigate what meds to use.

Small disclaimer: If your child has any one symptom that is particularly worrisome (e.g., a terrible cough), has gone on for a long time (i.e., more than 10 days), or makes you worried that it is more than just a common cold, you should see your doctor. Also, I didn’t specifically address the role of herbs and alternative options in this article (it’s a whole topic on its own).

Croup: My Kid’s Cough Sounds Like A Seal

I woke up in the middle of the night last night to sound of my son coughing. Within 5 seconds of being conscious, I recognized the familiar seal-like barky cough. Croup. Ugh. Some kids are just prone to croup, my son is one of them. Croup is just the name of the illness that causes this distinct barky cough. The sound comes from the swelling of the airway around the voice box (larynx). Naturally, it happens more commonly in really young kids (typically sub 5 years) because they have smaller airways to start with. Almost always it is caused by a virus and the most common offender is parainfluenza. (Not to be confused with influenza, for which you get a flu shot).

Croup is a typically a fall and winter illness (simply because there are more viruses lurking this time of year). And unfortunately, like all viruses, there is no cure.

So what to do?

These home remedies may help:

  1. Wrap your little one in a warm blanket and take him out in the cold night air. The cold acts like putting ice on the airway and decreases swelling (be patient though, your kiddo may cough more the first 30 seconds as a reflex to the cold).
  2. Go into your smallest bathroom with a shower. Turn the water on as hot as it will go and get the bathroom super steamy. Breathing in the steam can help break up the mucous and settle the airways.

When to see your doctor

See your doctor if your child makes a funny noise with breathing (like a throaty squeaking or whistling sound, called stridor) or seems to be struggling to breathe. Your doc will likely give your child a steroid (e.g. Decadron) to help with the swelling. Sometimes in an ER setting, a doc will use a breathing treatment with epinephrine (Note: it requires 3-4 hours of observation). As always, antibiotics don’t treat viruses and aren’t indicated in this condition.

I think, I better to go bed early tonight as I’m likely to be up again tonight (as croup tends to last a few days and is worse at night). Wish me luck!

-Photos courtesy of

How To Prevent Illnesses From Spreading

“Are we all going to get it?” is one of the most common questions I get after diagnosing an illness in a member of a family.

The short answer is, “Probably.” I don’t mean to sound flippant about it, but the truth is that most young children are good at spreading their germs (they don’t cover coughs or wash hands enough) and most moms and dads can’t keep up with disinfecting surfaces. If you manage to contain an illness to one family member, you are to be congratulated. Here are a few simple things you can do to increase that likelihood:

  • Cover your cough. Teach kids to cough into the crease of their elbows. If they cough into their hands and then touch everything, it’s not much better than spewing it into the air.
  • Wash hands with soap. Anytime you blow your nose, wash your hands. It is also a good habit to wash your hands when you first get home from an outing where you are exposed to the public and unclean surfaces. Also, wash hands before eating
  • Hand sanitizer. I love this stuff. You can use it just about anywhere, before eating in public places, after playing with others’ toys, etc.
  • Keep your distance. There is wisdom in keeping the sick ones apart from the healthy ones. If you can limit your sick child to one or two rooms, you’ll decrease the risk of spread to everyone else.
  • Disinfect surfaces frequently. Disinfecting wipes are great for quick wipe downs of door handles, light switches, phones, remote controls, and other frequently infected surfaces. Some viruses can live on surfaces for up to 48 hours.
  • Don’t touch your face. If your sick child coughs in your face, gives you a big kiss, or generally goos you, you are pretty much a goner. However, as you are out and about (touching infected surfaces in the world) and helping your sick child, try not to touch your face. A quick nose itch of a hand with infectious particles on it may be all it takes to catch the bug.
  • Eat healthy. Give your body a fighting chance with good nutrition. Some vitamin deficiencies can make you more susceptible to illness (e.g., vitamin D).
  • Get enough sleep. When your body is sleep deprived your immune defenses are down. You must get adequate sleep for your white blood cells (which are important in fighting infection) to work properly.
  • Vaccinate. I am a big believer in vaccinations. Some causes of infections, such as meningitis, pneumonia, ear infections, and pertussis (whooping cough) can be decreased or completely prevented by vaccinations. An annual flu shot is also a good idea.