How long does a asthma cough last

An asthma flare-up is when asthma symptoms get worse, making kids wheeze, cough, or be short of breath. An asthma flare-up can happen even when asthma is controlled.

Asthma flare-ups are also called asthma attacks or exacerbations.

What Happens in an Asthma Flare-Up?

Asthma is a disease of the breathing tubes that deliver air in and out of the lungs. When someone has asthma, these airways (also called bronchial tubes) might be slightly inflamed or swollen, even when the person seems to be breathing fine.

During a flare-up:

• The inflammation gets worse. Sticky mucus clogs the airways and their walls get more swollen.
  
• The muscles around the airways get tight, further narrowing them (this is called bronchoconstriction).

These problems leave very little room in the airways for air to flow through — think of a straw that's being pinched.

What Causes Asthma Flare-Ups?

People with asthma have airways that are overly sensitive to some things (called triggers). Being around triggers can bring on asthma symptoms.

The most common trigger in kids are viral respiratory infections, such as colds. Other common triggers include:

Many people with asthma also have allergies, which are another important flare-up trigger.

If not treated, a flare-up can last for several hours or even days. Quick-relief medicines (also called rescue medicines or fast-acting medicines) often stop the symptoms pretty quickly. A person should feel better once the flare-up ends, although this can take several days, especially if a viral infection was the trigger.

What Are the Signs of an Asthma Flare-Up?

Asthma flare-ups can vary in strength and length. They can happen without warning, causing sudden coughing, shortness of breath, and wheezing.

Flare-ups should be treated right away. So it's important to know their early warning signs, including:

• coughing
• throat clearing
• fast or irregular breathing
• being very tired
• trouble doing everyday activities
• restless sleep or coughing that prevents sleep
• mild chest tightness or wheezing
• shortness of breath

If the flare-up is severe, a kid might:

• struggle to breathe or have fast breathing even when sitting still
• be unable to speak more than a few words at a time without pausing
• have retractions (sucking in of muscles in the neck and chest) while breathing in

Because they can be life-threatening, flare-ups demand attention. Your child might need to take quick-relief medicine (which acts quickly to relieve symptoms), visit the doctor, or even go to the hospital.

Following the instructions in your child's asthma action plan can help you know what to do when a flare-up happens.

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What is cough variant asthma?

Cough variant asthma (CVA) is a type of asthma that presents with a dry cough as the only symptom. The cough is also usually unaccompanied by mucus from the respiratory tract.

Cough variant asthma is a common cause of chronic coughs that can last more than two months.

How is cough variant asthma different from other types of asthma?

Unlike other types of asthma, CVA only presents with a dry, minimally productive cough as the primary symptom. If you have CVA, you are unlikely to exhibit other typical asthma symptoms such as wheezing, chest tightness, and shortness of breath.

Who can get cough variant asthma?

CVA can affect anyone, but it is more common in children¹. CVA may eventually evolve into classic asthma if not treated.

What causes cough variant asthma?

According to research², cough variant asthma shares several features with classic asthma, including the tendency to develop allergies. Therefore, potential triggers of traditional asthma attacks may also apply to your case. Triggers include:

• Exposure to allergens such as pollen, dust, mold spores, and dust mites

• Smoke and other air pollutants

• Exercise

• Cold air

What are the symptoms of cough variant asthma?

In addition to a dry cough that lacks phlegm or mucus, you are likely to report other symptoms, including suffering from airway inflammation and being more susceptible to allergies. You also may experience narrowing of airways when predisposed to allergic stimuli, medically known as airway hyper-responsiveness (AHR)³.

How is cough variant asthma diagnosed?

It can be challenging to diagnose cough variant asthma since it does not present with typical asthma symptoms such as wheezing, shortness of breath, and chest tightness. However, your doctor can find out if you have a suggestive medical history of the condition and conduct several tests to determine your lung function.

Pulmonary function tests

The doctor tests your lung function, which involves measuring your lungs' capacity to function correctly during inhalation and exhalation.

One such test is spirometry⁴. This involves breathing into a spirometer, which measures how much air you can breathe out in 1 second (forced expiratory volume in one second (FEV1))⁵ as well as the total amount of air you can breathe out of your lungs (forced volume capacity (FVC))⁶.

The test is repeated after taking a bronchodilator that opens the airways. Based on the difference in these to the baseline readings, the doctor will be able to determine whether you have asthma. However, this test form cannot be used in younger children whose lungs have not fully developed.

Bronchoprovocation challenge

Spirometry tests are not always conclusive because you can still obtain normal results even with cough variant asthma. The doctor may thus carry out the bronchoprovocation⁷ test to ascertain your condition. These tests entail exposure to substances that may trigger an allergic reaction. Common bronchoprovocation challenges include:

• Exercise challenges⁸: A healthcare professional may ask you to conduct a physical task such as jogging or walking and measure your lung function before and after the exercise. You may start coughing after exercise if you have cough variant asthma.

• Irritant challenge⁹: The healthcare professional will expose you to irritants or allergens that trigger asthma and monitor your airways for hypersensitivity.

• Methacholine challenge¹⁰: During this challenge, you will inhale methacholine, a drug known to narrow your airways. Afterward, the doctor will observe your readings and compare them to the initial ones before taking the drug. If your lung function drops by at least 20%, the doctor may diagnose you with asthma. The methacholine challenge is usually more conclusive. It is done even when a spirometry test returns normal or ambiguous results.

Still, bronchoprovocation does not always yield informative results, as people with cough variant asthma are less hyper-responsive than those with classic asthma. Therefore, the tests may not always diagnose cough variant asthma.

Breath test

Elevated fractional exhaled nitric acid levels are symbolic of airway inflammation and can thus be used to diagnose classic asthma and CVA. Measuring the amount of this inflammatory gas released from your lungs can be used to conclusively determine the presence of cough variant asthma, where symptoms of classic asthma do not accompany the dry cough.

Differential diagnosis

Tests for other conditions may be carried out to rule out other causes of chronic coughs, such as:

• Vocal cord dysfunction¹¹: Your vocal cords fail to open up fully, leading to blockage of the airways. The disease is often mistaken for asthma, including forms such as CVA.

• Cystic fibrosis¹²: Inherited genes cause this disease. The disease may affect the digestive tract and the breathing system. The disease could also affect other organs. The disease has similar symptoms, such as lung infections, wheezing, and coughing, which may be accompanied by heavy mucus. The condition mainly affects the cells that produce sweat, mucus, and some digestive juices. Most people with cystic fibrosis are diagnosed as babies or children. 

• Pulmonary embolism¹³: This refers to the blockage of arteries in the lungs. It may be caused by other illnesses, such as deep vein thrombosis (blood clotting in the legs). Your doctor should check for blood clots to ensure that they are not the cause of blockage in the breathing system. However, the disease differs from CVA because chest pain and shortness of breath may accompany it.

• Congestive heart failure¹⁴: The condition is chronic — it develops over a long time and keeps reoccurring. In the case of congestive heart failure, the pumping of the heart muscle is affected gradually. Fluids may then accumulate in the lungs. You could experience shortness of breath. Your doctor may administer other tests to establish whether it is CVA or congestive heart failure. The illness differs from CVA in that it often involves swollen legs and a history of heart disease, such as a previous heart attack.

• Chronic rhinosinusitis¹⁵: The condition involves blockage of the sinuses and nose. The shortness of breath that may result could be confused with CVA — mainly because it lasts for a long time. In the case of chronic rhinosinusitis, unlike in CVA, mucus drips from the nose to the back of the throat. You may also observe a reduced sense of smell and experience facial pain.

Treatment for cough variant asthma

The treatment for CVA is similar to that of asthma in aspects such as oral medications, inhalers, and nebulizers. You should consult your doctor when you experience unusual signs, such as your fingers turning blue. You should also seek medical help when your medication fails to act as expected.

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