Today’s reader response comes from my email and asks a question I used to have myself, back during the early days:
In an old post on your site, you mentioned that you used to mistake your daughter’s asthma flare-ups for colds (please forgive me if I misread). I am currently under the impression that the only thing that triggers my daughter’s asthma is the common cold, because her flare-ups are accompanied by other cold symptoms.
Before she was on preventative medication, she had one very serious flare-up that started with a cough and progressed to an ER visit; after the flare-up was under control, she spent the next few days going through cold symptoms such as a runny & stuffy nose, productive cough, etc. But could that runny nose have been a result of the asthma attack? How can I be sure there was actually a cold virus involved? What if it was something else that set off the worst flare-up she’s endured – how can I differentiate?
I hope this question made sense… she’s only four, she’s had three colds in the past two months (though no ER visits, thanks to her meds), and I just don’t want to be misinterpreting anything. I guess my question boils down to, would you see a runny, stuffy, and/or yellow-green nose during an asthma flare-up if there isn’t a cold involved? – Jenny
My answer’s coming later as soon as time permits, so meanwhile why don’t you take a shot at it? Got any advice for Jenny?
To decipher asthma from a cold, it’s important to know the common symptoms of asthma including the big four: Coughing, wheezing, chest tightness, and shortness of breath. However, there’s many other symptoms that can be caused by asthma, including fatigue, irritability, poor exercise tolerance, etc.
But since most people with asthma also have allergies, it’s also important to know common allergy symptoms for various allergic conditions (including allergic asthma).
Finally, compare asthma and allergies to colds, likely with a table like this one (unfortunately, I couldn’t find a table that included asthma).
A big thing, I’d say, is that if it’s a cold, the nose symptoms typically wax and wane, and sinus/ear troubles are common. I never have ear troubles from allergies, and my allergies have to be really out of control before my sinuses get in on the game. By contrast, with allergies, my nose bugs me all the time at a steady level, and itchy eyes, itchy skin, eczema flareups and hives all show up for me. If it’s asthma alone, I have -no- cold symptoms aside from the cough.
A good litmus test for me (and the one recommended by my allergist) is to try a quick-acting antihistamine like Benadryl. If my symptoms improve greatly, I know it’s my allergies. If they don’t improve, I know it’s a cold. (I’ll admit that I’ve got a bit of a cheat in that I’m a very allergic asthmatic. Someone with a type of asthma that has less of an allergic component to it might not find that as useful – and of course, check with a pharmacist or doctor if it’s safe for you to use antihistamines before you try them – they’re contraindicated in some people).
I have a 4 yr old little boy and we are just learning how to control his cough variant asthma and trying to figure out the trigger. The question you pose is of great interest to me- I am eagerly looking forward to any and all responses. Also looking for any tips anyone can provide. I’m glad to have found this site!
I have just read as much of this much needed asthma info as my sleep deprived brain will allow. I’ve been up for the better part of 2 days helping my guy through another attack. We’ve had pneumonia once already this month and now are in our 2nd go-round. Triggered by his cold or ??? I’m a bit overwhelmed by all I need to do and how much my thinking needs to change. I’m also really pissed off at the complete lack of education from the doctors I’ve taken my son to for help.
The coughing has eased up for now so I better go sleep. I’m wondering if anyone can point me in the right direction for vacuums and true allergy bedding/covers? Thanks!
Jen, if I were you, I’d look at this post by Rick Frea and consider taking your son to see a specialist. You should also ask his doctors for a written asthma action plan with clear instructions on what constitutes “green zone”, “yellow zone,” and “red zone.”
The other thing I would suggest you do is to see if there’s an asthma education program in your area. They’re pretty common in Canada, but Amy said in the comments of one of her earlier posts that they aren’t common at all in the States. If you have one in your area, see if you can get in on it – they’re worth their weight in gold.
Regarding vaccuums, I was told by my allergist that central vac with a HEPA filter is ideal, central vac with no HEPA filter is second best, and if you don’t have central vac, anything with a HEPA filter will work fine. For air purifiers, my allergist didn’t think they were worth it, but he’s a big fan of humidity control (keeping humidity above 20% but below 50%) because it helps prevent mold so if you live in a very humid place, a dehumidifier might be a good idea, and if you live in a dry place, a humidifier would be a good plan.
As for the allergen sheets, my allergist said that you want one that completely encases the mattress and has a zipper. The elastic covers that don’t seal aren’t nearly as good. Beyond that, I don’t have any specific brands or anything… can someone else help with that?
Wow. Thanks, Sarah. I feel like I should make you comments moderator, lol.
Jenny & Jen–First off, in the original comment/question the beginning bit about my daughter is absolutely right. Before she was diagnosed at 2 years, AG just seemed like she got sick all the time. She was my first child, and I was young and inexperienced with babies, so her constant cough and lingering “colds” didn’t seem out of the ordinary to me. Once I learned more and got more proactive about her health and she started having better control around age 5, I could look back and see that during those months-long ordeals, she was cycling. She’d pick up a cold or flu-like virus, her undiagnosed asthma would flare, she’d eventually recover from the illness but the asthma cough would stick around, and then she’d get sick again because the constant flaring kept her resistance down.
As far as I know and from what I’ve seen myself, I don’t think an asthma flare alone can generate nasal symptoms. If you’re seeing a runny/stuffy nose, then I’d definitely be looking for an illness or, as Sarah mentioned, allergies.
In the original question, the progression went like this: cough–>bad flare/ER visit–>cold symptoms during flare recovery.
I’m wondering if your daughter picked up the cold at the ER while she was there for the asthma. Those places are so full of germs, but it’s a catch-22. The very place we take our kids during breathing emergencies can send them home with another health issue altogether!
About a year ago, I wrote this primer on the first steps to take after getting the diagnosis:
http://www.theasthmamom.com/2009/11/18/a-roadmap-for-asthma-maintenance/
I wrote it because it’s something that would’ve helped me in the beginning, and I wish my daughter’s doctor at the time had told me something similar. I also wish I’d educated myself sooner and gotten more aggressive with her asthma from the very beginning, but that’s another post.
One of the best ways to help your kids is to pin down all their triggers as soon as possible. I’d absolutely recommend allergy testing to anyone new-ish to asthma, even if you don’t suspect allergies. It’s not always accurate in young kids, but testing can uncover triggers you didn’t realize were even affecting your child.
For pillow and mattress covers, make sure you get the zippered ones labeled “allergen-free” as Sarah mentioned. I buy mine at Target – they’re in the bedding section with the regular pillow covers – and they work great.
Sarah also had great advice about the vacuums. I use a regular one w/a HEPA filter. I’d love a central vac, but the regular ones are way more affordable, and the Asthma Mom household lives on a budget.
I hope all this helps, and welcome to the site!
Jen–I wanted to add, I was in your shoes when my daughter was around that age. No educational help from doctors, up all night all the time, etc. Please let us know if you have any more questions, and I hope things ease up for your son soon.
Thank you so much for publishing my question. These comments are so informative, and I really appreciate the guidance.
Luckily, we do have an asthma action plan here; unluckily, the cold my daughter caught at the beginning of this month has caused a cough that is still lingering even now, despite her having been on Flovent and Singulair all autumn. The cough is mild and not disruptive to her, but it’s still there! It mostly occurs after she gets out of bed in the morning, and while she’s eating (anything).
Her salbutamol does nothing for it – actually, seems to make it a bit worse. I can’t wait to bombard her paediatrician with more questions next week – but what I wouldn’t give for a doctor with whom we could make a same-day appointment, when I have concerns.
Her paediatrician has already referred her to an allergist, but unfortunately the waiting list is ten months long. She has pretty obvious seasonal allergies, but her asthma hasn’t flared up during those, only at the beginning of what ends up progressing like a standard cold (i.e. the stuffy nose worsens then improves over about a week).
I have been gobbling up all the information on your site, and am so glad you’ve written about this so extensively. Thanks again for this post… nothing has helped as much as the perspective of other parents and asthmatics.
And Sarah’s comment is great – to me it does sound like the recent illnesses have been colds. I have noticed that my daughter’s nose doesn’t get very stuffy / runny during the allergy seasons… she’ll sneeze repeatedly, have red watery puffy eyes, but the nose just gets a little watery and clear. During colds her congestion is extreme!
Though I imagine that even if allergies don’t trigger your asthma, they probably still add to the load on your lungs, making you more sensitive to whatever does trigger your asthma…?
You’re welcome!
And that’s a good question. Can you have allergies that don’t trigger your asthma? My daughter’s not an allergic kid so my experience is with intrinsic asthma – AG has the typical asthmatic’s dust mite allergy and is apparently developing an eye sensitivity to ragweed, but that’s it. In fact, her main trigger is illness, just like you suspect w/your daughter.
I would think any allergy would definitely trigger asthma, but I just don’t know. I never considered the alternative!
My knowledge is second hand from my allergist, but my understanding is that it kind of depends on how badly you react. If your sensitivity consists of mild contact dermatitis to something, it probably won’t affect your asthma, but if you have a systemic reaction (full-body hives, eczema, etc), you’re far more likely to have it affect your asthma. Something like allergic rhinitis, he said, is in the middle – it may affect your asthma, or it may not.
For me, I have contact reaction to spruce trees, but it doesn’t affect my breathing. By contrast, cats, dust, and hay immediately tank my breathing. Dogs, horses and cattle are somewhere in between – usually my allergies already have to be flaring before they’ll affect my breathing. For pollen (like cute and furry stuff, I’m allergic to all the pollens they test for, and then some), my reaction varies based on the concentration on it in the air (nasal symptoms hit first, followed by asthma, followed by – if it’s really thick in the air – hives and angioedema), and my sensitivity to mold is questionable (I have a pattern of asthma flares when mold counts are high, but we’re not sure if that’s due to ragweed, which is also seasonal during mold season, and we know I’m very sensitive to ragweed – I’ll react when it’s barely at the detection limit).
The rule of thumb he said is: the worse the reaction, the higher chance of the asthma getting in on it.
That said, I have an exception to the rule with this: I have almost no reaction to dust aside from asthma attack. Sometimes I’ll get angioedema in my hands and lips from it, but for that to happen, there’s got to be a tonne of dust around, and I have to have had contact with it for my hands to get in on it. Usually, my asthma is my only sign there’s dust around. By the time there’s enough dust for my hands and lips to swell, I’m in so much trouble breathing, I’m already fleeing the area and sucking down salbutamol.
It’s definitely possible that my daughter’s allergies so affect her asthma, but so mildly that neither her nor I can tell – but I’m getting pretty good at knowing what her normal breathing rate is, how she should normally be acting (i.e. she never gets tired, unless there’s a health problem brewing!).
Her allergies in the spring and late summer are pretty apparent – a big field of recently-mowed grass will have her sneezing like crazy! But maybe her symptoms (sneezing and watery eyes) would constitute a mild allergic response.
To me it’s a bit strange that her seasonal allergies wouldn’t give her trouble breathing, and don’t induce coughing, given how severe her asthma attacks can get during a cold. But I don’t assume that her allergies will never affect her breathing, because if I’ve learned anything, it’s that this condition evolves and is not as predictable as I would like it to be!
Being around a lot of barbecue smoke this summer did have her doing this tiny little cough every few minutes, which I would interpret as an asthmatic response… so I can see that she’s capable of reacting to more than just viruses (unfortunately).
I hope her allergist will entertain my millions of questions on this subject… I am so hungry for knowledge at the moment!
* I meant “do affect her asthma”, not “so affect…”, oops.
Okay, so that makes sense re: mild allergic reactions probably not triggering an attack. With the kid’s developing ragweed sensitivity, for example, (it’s probably a “true” allergy, but she hasn’t been tested recently) her eyes turn bright red/scratchy/dry and water like crazy, but her breathing remains unaffected.
Interestingly, a dusty room has never bothered her very much, but the dust mites in an uncovered pillow & mattress will keep her up all night long.
Keep us updated, Jenny!
Here I am again. We made it a little over 2 months. My little guy has had a cold (maybe allergies) for the past 5 days and tonight is cough turned on us. I told my husband at dinner that I thought this was going to be a rough night. Sure enough. I woke lil guy up and gave him benadryl, blew his nose and gave him water. That was like winning a minor war- let’s hope I don’t have to neb tonight as I don’t know how that will play out. Now I wait (DH is sound asleep. Why is it that mom’s are usually the only ones who lose sleep?)
In the past few months we’ve instituted heavy duty dusting and vacuuming. I invested in a Dyson Animal and love it.
I am sitting on the couch timing his coughing to see if I can get a sense of it worsening or if the benadryl will have a positive effect.
Wish me luck ladies! I feel a sleepless night coming on…