Expert: Bailey - 2/12/2007

Question
my daughter is 5 years old now; when she was three she was seen for the first time for a bronchospasm. from october until early december i had my daughter in clinics, ped's office and ER at least 1-2 times a week; Her brother, grandmother and great grandmother all suffer/suffered from asthma. I was finally given the diagnosis of asthma early december and then last year I had to change pediatricians as i changed to a different job. Well now i am getting the same run around regarding this unbelievable cough she suffers from. It is worse at night and early morning, it sounds as if it is croup because of the sound but she has no other signs or symptoms of croup or upper respiratory infection. The problem that we have is that she has never wheezed either audibly with a stethoscope or without; so they keep saying if there's no wheeze theres no asthma. forgetting the fact that her pulse ox has dipped as low as 94%, she's complaining of not being able to breath and that her chest hurts and there are visible retractions and her face is pale with bluish tinge to the underneath of her eyes and lips. They have put her on every kind of narcotic cough suppressant known and this does absolutely nothing for her cough. And now recently i was told that her bronchial tube isn't inflamed so albuterol would do nothing for her; well at that point couldn't it be that the tube was open, but at night the muscles around the tube cause airway constriction?! I'm at a loss and completely frusterated. any help and advice is apreciated.  

Answer
Hi Dana,
With the symptoms described and the fact that several family members have asthma would lead me to believe this could be asthma. It is very common for asthma to be worse at night and the early morning hours. For some people, they may have bad symptoms during this time frame and be relatively okay during the day. The idea that you MUST wheeze to be asthmatic is also false. Wheezing is only one symptom of asthma. Most asthmatics will wheeze at some point but there are asthmatics who don't wheeze at all. A pulse ox of 94% in a 5 year old would definitely be an indication of a potential respiratory problem. If these problems are continuos and the pulse ox is persistently low, then I would suspect asthma or some form of a chronic lung condition. You might want to see if you can get a peak flow meter, which measures lung function, as this could be helpful in determining patterns in her breathing problems. I would also be persistent about trying to get an albuterol inhaler. It surprises me that one would not be prescribed given the previous diagnoses of asthma and your daughters symptoms. Cough syrup is generally not a good idea for asthmatic patients as well, especially if there is no apparent benefit. There are no real diagnostic tests that can prove or disprove asthma, therefore a solid diagnoses can take some time. Other conditions are looked at in the process in an attempt to rule them out as the source of the problem. It is very possible that your daughter is asthmatic, but there are other things it could be as well and it sounds like the pediatrician is looking at other things. It never hurts to get a second opinion from another doctor though if thats an option. I wish you and your daughter the best with this.
-Bailey