Hello, my son has some confusing symptoms and I am hoping you can maybe help me make some sense of it all?I apologize in advance that this is so long!

My son has had asthma since he was one. He started out with wheezing and congestion and sob, night coughing, gagging, vomitting up mucous, frequent ear infections, frequent URI's. Then the wheezing went away and he would have all of the other symptoms immediately during and after each URI. He had ear tubes placed, so the ear infections went away, but all of the other symptoms remained. As long as he didn't have a cold he was fine, but as soon as a cold hit all of the asthma issues would flare. We saw a pediatric allergist and had testing done with no allergy results, but he did say that it sounded like asthma and prescribed pulmicort, albuterol and singulair to be taken at first sign of URI, then when he was well we would stop the medications. Well this has been the coarse for the past 2 years.

Well, for the past 2-3 months he has been hoarse with no obvious cause. I started him back on singulair and we started him on zyrtec in case it was allergies, well this did nothing to help the hoarseness. He also began having asthma flare ups with out a URI as trigger, such as night coughing, exercise induced coughing etc. which I understand is not a good sign.
Well I started looking into causes for hoarseness and came across reflux, looking back on his history this would really make sense as he spit up huge amounts up until he was 18 months, I mean HUGE amounts.This could also be a contributor to his asthma I understand.

Okay now to my question...=)...his most recent symptoms have been a horrible cough, worse at night, it has almost sounded like a bronchospasm, he would cough so hard and gag at the end of each cough and so frequently that he wouldn't be able to get a breath in between, I would blow the albuterol in his face and just pray that it would stop. He did this for about 2 weeks, then I think he got a URI on top of it and ended up with a fever so I took him in to the doctor and they put him on prednisone to help get the breathing under control.

The thing that confuses me is that this whole time his lungs sound fine in the bases (I am a nurse) he has alot of upper airway congestion, but there is no wheezing or crackles to be heard, the doctor couldn't hear any either. However the prednisone was like a miracle, the second night he was on the prednisone he slept through the night, the hoarseness went away, and the coughing was dramatically better. But is it normal to not hear any wheezing with asthma? If reflux is causing the inflamation in his lungs would it make sense that the irritation would be upper airway rather than lower?

If you made it to the end of this thank you!!!!! If you have any ideas I would really appreciate it.

Thanks for your question. The first thing I thought of while you were describing his early symptoms was reflux. These symptoms are pretty common here at IRD with our refluxers. He could certainly be refluxing, triggering a protective cough and bronchospasm It is also quite possible that he may be aspirating slightly, hence the upper airway noise. My honest opinion is that he may have both reflux and asthma. One often exacerbates the other. Have you seen a ped Pulmonologist? I don't think that would be out of line given your son's history of asthma symptoms. As for wheezing with asthma, not everyone wheezes. I personally cough when I have an attack. I almost never wheeze. Cough is as much a symptom of bronchospasm as the wheezing. When the bronchospasm is particularly severe, you may not hear anything out of the ordinary, just diminished breath sounds. In my opinion, you have a pretty good med regimen in place for your son's asthma. My only suggestion would be to continue the Pulmicort everyday regardless of symptoms being present. As this is an inhaled steroid, it takes up to two weeks to see full effect from the Pulmicort. It should be taken everyday (whether you think he needs it or not) to be truly effective. When you think he doesn't need it, consider that proof that the Pulmicort is working.:hug:

Hello and thank you so much for taking the time to answer my questions. We actually saw a pediatric pulmonologist today. He didn't have the best bedside manner, but he helped get us on a good plan. He said the same thing you did about keeping him on the inhaled steroids whether he was having an exacerbation or not, but we switched him to flovent inhaler as my son HATES the nebulizer, and it is such a battle to get him to sit still and take the whole thing. I am hoping that will help.

When I told him we were thinking possible reflux due to the voice hoarseness and his history he mentioned that alot of people are jumping on the "reflux bandwagon" which kind of irritated me, it is what it is, I just want someone to look at the symptoms and not have any preconceived ideas.

We decided we would keep him on flovent and singulair around the clock, give him zyrtec according to the pollen counts and his symptoms as well as the trial of reflux meds (prevacid) and then in 3 months reassess the hoarseness and asthma episodes. If he is still having problems with both we will have the pulmonologist and gi docs get together and do an upper endoscopy, ph probe and some other test to check the lung function, I can't remember the name, laryngo-something.....? So, I feel better that we have a plan in place.

Anyway, thank you again for the reply and input, I am sure I will have many more questions in the future.

For the most part, it sounds like you had a productive appointment. I think you will see improvement with continuous use of the Flovent and the Singulair. Just don't stop when you think he's feeling better. I don't think a 3 month wait is out of line to see if the symptoms improve, but keep the GI in the loop. I hope your little one is feeling better soon.