Coughing due to inhalation?

Question

Hello,
our son is 2 years old now. In August, CF has been diagnosed.
Since september we inhale regularly.
Even after the first inhalation he started coughing at night. Since then he coughs several times a day really hard. He gets N-acetyl-cysteine regularly and since one week also antibiotics. That has not changed anything however. Before the antibiotic therapy a swab had been done, this was negative for Pseudmonas. Is there the possibility that he does not tolerate the inhalation (only with saline) ?
Does something like this exist? Or do you have an advice what can be done here!
Thank you very much,

Answer

Hello,
in general every inhalation can cause a stimulus for cough in case of a hypersensitivity of the airways (bronchial hypersensitivity). Furthermore it could have been shown that for example inhalations of antibiotics can lead more often to a short-termed narrowing of the bronchi.
In these cases it should be found out, if the widening of the bronchi with inhalative drugs such as salbutamole can suppress the complaints (e.g. used as a spray with an inhalation help = spacer). In some CF children a bronchial hypersensitivity can be well controlled by asthma-medications.
The cough at night of your son with an extended time-interval between the inhalation could probably also be founded by a late inhalation of mucolytic drugs before going to bed. Hypertonic saline, not those with 0.9% Sodium Chloride concentration, but in Germany with up to 6% Sodium Chloride concentration or DNAse could here have a bigger effect.
Possibly the cough of your son is caused more by an infection than by the inhalation. Probably the prescribed antibiotics by your CF-pediatrician has already shown a posivite effect here.
In case nothing has changed with that, also a trial to leave out the N-acetyl-cystein could be considered.
Yours sincerely,
Dr. J. Mainz

17.01.2010