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Suggest Treatment For Nasal Congestion And Persistent Cough
Question: My 6 year old daughter had a sinus rinse; Tonsils & Adenoids removed XXXXXXX 5th. All associated symptoms gone upon surgery. She started swimming XXXXXXX 22nd. Started sneezing & clear nasal dischg. Pedi ENT suggested Alfrin for nasal congestion. No congestion - nasal passages were clear. continue swimming everyday. Today sneezing is nonexistence ;however dry, barky cough is persistant. I have given her xyzal; delsym; and sprayed her nose with alfrin. She stated that she did swallow some water today during her lesson but it wasn't alot. I stopped her Flovent two weeks prior to her surgery. Usually the doctor would recommend stopping the flovent in the summer & start pulmocort. But I didn't see the benefits since her coughing was related to the tonsils; adenoids issues per the pedi ENT.
Brief Answer:
It may be bronchial asthma
Detailed Answer:
Hello
Thanks for the query
The present symptoms(persistent dry barky cough) can be due to asthma.
Both of these condition asthma and tonsillitis can present separately or together and with similar complaints like nasal congestion,nasal discharge and cough.
The symptoms should have subsided now if it was due to tonsillar inflammation.The another possibility is that there may be some residual inflammation of the tonsil and it may take some more time to recover.
But the symptoms respond very well to flovent(fluticasone steroid)or pulmocort(budesonide steroid) in case of asthma.
Most of the cases of tonsillitis don't need steroid treatment.
So I would suggest you to give the flovent(more effective than pulmocort with not much difference in side effects) to get relieve in the cough along with Xyzal,deslym and alfrin.
Get her evaluated by a pediatrician for clinical evaluation and to rule out any cough variant of asthma if any.I don't think it is related to swimming or swallowing of pool water.
I hope this answers your query.
I shall be glad to answer if you have any more query.
Reagrds
It may be bronchial asthma
Detailed Answer:
Hello
Thanks for the query
The present symptoms(persistent dry barky cough) can be due to asthma.
Both of these condition asthma and tonsillitis can present separately or together and with similar complaints like nasal congestion,nasal discharge and cough.
The symptoms should have subsided now if it was due to tonsillar inflammation.The another possibility is that there may be some residual inflammation of the tonsil and it may take some more time to recover.
But the symptoms respond very well to flovent(fluticasone steroid)or pulmocort(budesonide steroid) in case of asthma.
Most of the cases of tonsillitis don't need steroid treatment.
So I would suggest you to give the flovent(more effective than pulmocort with not much difference in side effects) to get relieve in the cough along with Xyzal,deslym and alfrin.
Get her evaluated by a pediatrician for clinical evaluation and to rule out any cough variant of asthma if any.I don't think it is related to swimming or swallowing of pool water.
I hope this answers your query.
I shall be glad to answer if you have any more query.
Reagrds
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX - She didn't have any symptoms until she started swimming. Immediately after swimming 6/22, the sneezing with nasal discharge. The past 3 years of swimming, she has been allergic to the chlorine in the pool. I have always rinsed her nasal passages with saline after swimming but this is the first year I am aware of sneezing with nasal discharge. (usually it would be nasal congestion) The cough was not there last week or even after her surgery on XXXXXXX 5 but definitely today since it has been ongoing all day. She has not been diagnosed with possible asthma due to allergies but there has not been any documented cases. Even at her worst of coughing, the asthma was considered dormant. But I will definitely restart the flovent tonight. Any continue all other medications for relief. If not better by thursday, I will followup with a doctor. I plan not to allow her to swim until Saturday for the July 4th Holiday.
Brief Answer:
Still I would like to get her evaluated to rule out possiblity of asthma
Detailed Answer:
Thanks for the detailed history
I would like to know what was the clinical condition she was suffering from which needed steroid inhalation.
If there was cough initially and that responded to the inhalation,this itself suggests the possibility of some inflammation in the airway which can not be explained by tonsillar pathology.
The cough should not be there once the pathology has been removed(removal of tonsil and adenoid).
So still I would like to get her evaluated by a pediatrician to rule out the possibility of asthma if any.
Regards
Still I would like to get her evaluated to rule out possiblity of asthma
Detailed Answer:
Thanks for the detailed history
I would like to know what was the clinical condition she was suffering from which needed steroid inhalation.
If there was cough initially and that responded to the inhalation,this itself suggests the possibility of some inflammation in the airway which can not be explained by tonsillar pathology.
The cough should not be there once the pathology has been removed(removal of tonsil and adenoid).
So still I would like to get her evaluated by a pediatrician to rule out the possibility of asthma if any.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor. Thank you very much for the suggestion! She responded well to the flovent. We saw the allergist yesterday & he advised using flovent twice a day for a week & then daily. He didn't believe it was the swimming either. Tonsils are healing nicely. I'm giving the delsm (as needed); xyzal & flovent. Cough has subsided with occasional barky cough. Sleeping well. Doctor Didn't notice any post nasal during the exam so I stopped Alfrin. ?? Since the cough is still present - what is causing it to be present? And yes she was on flovent due to prior history of inflammation of her lungs and/or post infection cough. I'm willing to deal with anything except cough! Any suggestions to get ahead of it. Reminder - started on Tuesday?? dry, persistant... However, occasional now.
Thank you. XXXXXXX
Thank you. XXXXXXX
Brief Answer:
Don't worry.The cough will subside with the use of flovent
Detailed Answer:
Thanks for writing back.
It's good to know that she is responding to the flovent.
In many cases, nonspecific cough is related to postviral infection and increased cough receptor sensitivity. Resolution is spontaneous in the majority
of children.
In case of dry and persistent(>4 weeks) cough The XXXXXXX Academy of Pediatrics has recommended for the trial of inhalational corticosteroid(ICS) for the possible diagnosis of Asthma.
As the Post nasal drip syndrome has been ruled out by examination,cough has responded to flovent and it is dry in nature the other possibilities like sinusitis,bacterial infection are very unlikely.
If history of cough is less than 4 weeks it might be due to increased cough receptor sensitivity that is improving itself and we are assuming it to be due to the effect of Flovent.
I would like to continue the Folvent as child is responding to the Flovent and get her evaluated by a pulmonologist for the proper diagnosis.Don't get overly worried for cough as it should subside within a week.
I won't suggest you to give Delsym(dextromethorphan)as it is a cough suppressant and not recommended for use in children.
Regards
Don't worry.The cough will subside with the use of flovent
Detailed Answer:
Thanks for writing back.
It's good to know that she is responding to the flovent.
In many cases, nonspecific cough is related to postviral infection and increased cough receptor sensitivity. Resolution is spontaneous in the majority
of children.
In case of dry and persistent(>4 weeks) cough The XXXXXXX Academy of Pediatrics has recommended for the trial of inhalational corticosteroid(ICS) for the possible diagnosis of Asthma.
As the Post nasal drip syndrome has been ruled out by examination,cough has responded to flovent and it is dry in nature the other possibilities like sinusitis,bacterial infection are very unlikely.
If history of cough is less than 4 weeks it might be due to increased cough receptor sensitivity that is improving itself and we are assuming it to be due to the effect of Flovent.
I would like to continue the Folvent as child is responding to the Flovent and get her evaluated by a pulmonologist for the proper diagnosis.Don't get overly worried for cough as it should subside within a week.
I won't suggest you to give Delsym(dextromethorphan)as it is a cough suppressant and not recommended for use in children.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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