Cause of cough?

Question

Dear expert team,

my son (CF, 4 years old, 1.07m, 16.5kg, mild progression so far) rarely coughs when he does not have infections, only during strong physical action and sometimes after inhalation.

For some time now, he has also been having a continuous cough (dry nervous cough) that starts roughly during the first hour after going to bed. The CF clinic has therefore prescribed us Antra MUPS® (omeprazole magnesium) 20mg. Suspicion of reflux. A probe test was not done.

After about 6 weeks the problem was solved. We stopped the medication and were “cough-free” for about two months.

Currently the cough is back again. I am now wondering: could it be from the inhalation? Is it normal, and do other children with CF have similar symptoms?

Or is it perhaps reflux after all (apart from the coughing after going to sleep, my son does not have any typical reflux symptoms)?

Many thanks for your answer.

Answer

Hello,

You are saying that your 4-year-old son, who has CF, has had a very mild progression so far. He is coughing only occasionally during infection-free periods. Then suddenly you noticed a tendency towards nightly dry cough about one hour after going to sleep. Based on the suspicion of gastroesophageal reflux, your son was treated with Antra MUPS® (omeprazole magnesium) 20mg and the tendency to cough went away. After stopping Antra® your son was cough-free for two more months. Now he has started coughing again and you are wondering whether he indeed has reflux or whether other reasons could play a role, such as a reaction to inhalation.

The fact that your son’s cough stopped during Antra® therapy could indeed point to reflux, but does not prove it. Some CF patients temporarily react with nervous cough to various inhalation drugs. In most cases, though, this nervous cough appears early on and not only an hour after inhalation. You are saying that your son is inhaling. It would be important to know the name of the drug and the number of inhalations. In case your son inhales in the mornings and evenings, nervous cough would have to be expected in the mornings and evenings too if there is a connection between the cough and the inhalation. The cough should then not disappear during Antra® therapy, either. On the whole, dry cough is observed quite often in children with CF shortly after going to sleep. This is then usually due to the secretion running from the nasal area down the throat when they lay down. However, this actually only happens when there is an increased amount of nasal secretion, i.e. a slight cold.

Since it could indeed be reflux, and since the clarification of such a finding is very important in CF, I would like to suggest that you have a 24-hour esophageal PH-metry done for your son in order to get clarity. This is important, as a reflux disease can lead to aspirations into the lungs that could negatively influence the progression of CF.

All the best to you and your son.

Kind regards,
Dr. H.-G. Posselt

13.12.2012