Tuesdays are Your Turn – Bronchodilators and Coughs

This is a long one from my email, but please take the time to read the whole thing. It raises lots of questions that many other parents of young asthma kids have (I had them.):

If my asthmatic child is coughing (she’s too young for a peak flow meter btw) and I am using her bronchodilator how much should it help? How do I know if it’s helping enough or if it’s not working? Should it stop the cough when she takes it? Because it doesn’t. It seems like she coughs like crazy for the 30min before she’s due for a puff and the hour after she takes her puff. She coughs much less the rest of the
time but it never goes away completely. She doesn’t have symptoms of a cold so I’m pretty sure it’s the asthma.

None of the doctors I’ve talked to have explained well enough how well the puffer is supposed to help. Also when she takes her first puff, she coughs. Just once but from the puffer. Is that normal?

Not being a medical professional myself and answering purely as a parent, I’ll go out on a limb here and say that if your daughter has been coughing like this for awhile, it sounds as though she’s experiencing a prolonged flare and/or that she needs a treatment plan change to attain better asthma control.

My daughter reacted in a similar way to her bronchodilator when she was younger – her asthma cough would lessen but never completely leave – until we finally put her on maintenance corticosteroids and figured out her triggers. Essentially, we had to reduce her airway inflammation before her quick-relief treatments worked fully and made that constant cough disappear. Now, at age 11, she only coughs on and off throughout the day during the more persistent flares (about a week’s duration) and/or while sick.

Again, this is purely my opinion and not medical advice, but I’m guessing your daughter’s inhaler is not helping her enough, particularly if you don’t think she’s sick and if these symptoms have hung around for awhile. I’d make an appointment with her doctor to talk about stepping up her treatment plan, possibly by changing and/or adding meds. The doctor may also recommend daily inhaled steroids for maintenance if she’s not already on them or even allergy testing to pin down her triggers.

As for your last question, my kid also sometimes coughs once when she uses her bronchodilator, but only if she’s already flaring. If your daughter’s inhaler ever starts inducing severe or uncontrollable coughing, you may want to ask about switching to a different type.

That’s my two cents, and I hope it helps. How about it, readers? What do you think?

71 responses to “Tuesdays are Your Turn – Bronchodilators and Coughs”

  1. Samantha says:

    I tend to agree with you. My girl had a nearly constant cough and nothing seemed to help… until we A. put her on the inhaled steroid/LABA combo in Advair (the steroid alone in Flovent didnt cut it) and B. started treating her allergies more aggressively. Id think the inhaler isnt able to keep up just based on what I read… I cant say for sure but my gut and my own experience with a similar situation says talk to the doc,she may need a daily controller med

  2. Steve says:

    As Amy said, if your child is flaring, the inhaler would probably would not help all that much. I’m not sure if your using a mouth piece or a mask with your spacer , but in any case the medication that comes outs an inhaler is a powder, so for sure its going to aggravate her cough. .
    You might want to ask about a nebulizer to administer her meds when she flares like this. It will still make her cough, but you have a better chance of the meds getting down deeper in her lungs where they will do the most good. Sounds like she needs some anti inflammatory medications as well.

  3. Yes either it’s a more serious flare or she’s coughing for another reason.

    I guess the barometer we use is do we see a marked difference in our toddler with the inhaler? If yes then it’s asthma, if not, then it might be something else.

    So far the answer has always been yes. Although her asthma is pretty mild overall.


  4. Kelley says:

    I remember this all too well. Before my AG’s asthma was adequately controlled, she coughed like this. It would take 4 puffs of the ProAir to finally calm her coughing. This happened even while she was on the lower dose Flovent, and for the first few weeks of the increased Flovent dosage. Additionally, she had a lot of “upper” airway coughing (think croup) until testing showed she also suffers from GERD, which she takes medication daily for now. She has only flared since due to illness, and then her cough will turn “wet” after she takes the 2 puffs of her ProAir, usually 4 doses of this are needed per day while she is flaring, but ONLY if her symptoms are not caught soon enough. Most of the time now, quickly doubling her Flovent (per her dr.’s ok/orders) and/or adding oral steroids will fend this all off. I would advise finding a good specialist if you do not already have one, or if you do now, write down her symptoms and her reactions to bring to the Dr. and go over everything with them. Their job is to make sure the asthma is well controlled, including identifying any currently unknown triggers, and explain everything to you, since you are the daily caretaker in charge of ensuring the asthma plan is followed.

  5. kerri says:

    I agree with the others that maintenance medications need to be added or switched up. And, Steve up there is a ninja, and is part of the reason I have my nebulizer now–it helps so much more than inhalers do.

    Definitely though residual inflammation will make her cough, which needs to be treated. I also find that I sometimes cough after taking my inhaler. Amy’s also right about trying switching bronchodilators [if you’re in the states you’re also lucky to have the option of albuterol vs. xopenex, which up here in Canada, we don’t have the alternative].

    Definitely though talk to her doctor about this. Good luck!

  6. MC says:

    Just a thought here… My sister’s asthma is cough-varient, and my mom noticed that her cough would get WORSE when she’d take the ProAir, though it finally calmed down overall after the qvar started to kick in (like a week or two later). She uses Ventolin now, which from my observation (I haven’t heard my mom complain about it lately), seems to help more and not make her cough more like the ProAir did.

    On the same note with the ProAir, I can’t take that particular inhaler as it makes me itch like crazy head to toe. I’m fine with nebs and Ventolin, so my pulmonologist and I came to the conclusion that I’m allergic to the propellant (ethanol) in ProAir.

    So, maybe it’s more than just needing a steroid inhaler, or a change of steroid inhaler, but also a change in the rescue inhaler… or like Kerri pointed out about Ninja Steve that a nebulizer may help more. My nebulizer has been a tremendous help when I’m flaring badly or, especially when I’m sick. Whatever the case, this is something that should definitely be brought up with your doctor.

  7. Callista says:

    Hi there, I’m the one who sent the email, thanks for the feedback. I did end up going to doctor and he prescribed the orange puffer (flovent). However she still only takes it as needed, not constantly and the blue one is only for if she’s already taking the orange one and she is having a severe attack where she can’t breath.

    He said if she is coughing many times a day for a few days at a time every week, that’s too much.

    I found what Kelley said interesting. My daughter has had croup at least once and the doc said her cough sounded sort of croupish last week. She does have GERD but went off meds a year ago because as long as she didn’t have chocolate or anything too spicy, she seemed to not have symptoms. Perhaps I’ll try her back on something. I just wish she could swallow the pills, so much easier.

  8. lpnmon says:

    The orange puffer (flovent) will help your daughter more if it is taken continuously instead of just as needed. Unless as needed is for like a week at a time. It’s not a quick-acting medication, but a steroid that needs some time to work.

    At least, that’s my understanding of how they work. Since DS(6) was dx’d with asthma 3 years or so ago, I’ve researched the crap out of it. Plus nursing school, which actually taught me LESS than the stuff I did on my own. Talk to a pharmacist if your doc didn’t explain it well.


  9. Sara C. says:

    for swallowing pills…start out with mini m&m’s…have her swallow those..then, move on to regular size m&m’s before long, she’ll be swallowing pills like a champ. (we used broken of pieces of candy cane with my daughter…worked like a charm) I’m not sure how we taught our older daughter…it seems like she’s just always been able to swallow them…one of the meds she takes (unrelated to asthma) is only available as a pill, and she’s been on it since age 5 or maybe younger.

  10. Kelley says:

    Callista: My AG takes the “solutab” prevacid, which is also available as a generic. They are about the size of a smarty and dissolve in the mouth. I can’t, though, remember what the generic is called. Also, from what I know, it is useless to use the Flovent “as needed.” I can say from personal experience that it takes a good 3-4 weeks for the Flovent to work sufficiently enough to open the airways to improve symptoms to where the rescue inhalers are needed only rarely. You may find that the coughing drastically decreases by treating her GERD if that is what is bothering her right now. If not, you defintely should discuss with the doc increasing the Flovent to a daily dose. Side note on the GERD: My AG had it from birth and appeared to outgrow it at about 1, but … the testing she has when all this started (at 5) showed she still had it very bad (I still feel guilty that I didn’t realize she was suffering from it the entire time).

  11. Amy says:

    As everyone else mentioned, using Flovent as needed won’t help much (if at all), since it’s designed to keep a low dose of steroids in their airways constantly, preventing the inflammation that leads to attacks.

    I’ve been there. I know it’s hard to wrap your mind around daily meds for a young child. But using Flovent as needed rather than daily landed my daughter in the hospital when she was younger and probably caused her a full three years of weeks-long flares, interrupted sleep, multiple ER visits, and missed holidays.

    Using them daily instead (Sept. through May) turned her into a different child – a (relatively) healthy child.

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