Cough Variant Asthma Treatment, Causes, Symptoms, Diagnosis

Cough Variant Asthma Treatment, Causes, Symptoms, Diagnosis

What is Cough-Variant Asthma

Some children with a persistent cough have a condition called “cough variant asthma.” This means that we believe that the child is coughing because his or her breathing tubes (bronchi) are reacting to irritation by squeezing in to a smaller size, just like in asthma. Children with cough variant asthma do not make the wheezing sound that we usually hear in children with ordinary asthma, though. This can make it difficult to diagnose the condition, and very often children with cough variant asthma have been through a number of other diagnoses or treatments. Parents of children with cough variant asthma usually find that regular cough and cold medicines don’t help their children, and of course antibiotics don’t help either. Cough variant asthma can be a very frustrating condition.

Cough Variant Asthma Treatment, Causes, Symptoms, Diagnosis

Once of the most important clues to learning that a child has cough variant asthma is that these children very often get a cough with every cold or upper respiratory infection (URI). The cough usually lasts for much longer than the original infection. Like children with regularasthma, children with cough variant asthma usually have other “triggers” that can set off a cough. These triggers can be things in the environment like smoke, dust, pollen, animal hair and dander, dust mites, roaches or many other things. Often weather changes can also be triggers. Children with cough variant asthma often cough more at night, which can be very disruptive for the child and the family.

What Causes Cough-Variant Asthma?

Like "classic" or "typical" asthma, no one really knows what causes cough-variant asthma. However, coughing may start after people are exposed to allergens, or when they are breathing in cold air. Coughing may also follow an upper respiratory infection. For example, sinusitis with asthma is common.

The 3 most common causes of chronic cough are sinusitis, gastroesophageal reflux, and asthma. A given patient may have all 3 of these conditions, producing the presenting complaint of cough. In regard to cough-variant asthma, wheezing is considered to be sine qua non of asthma; however, it has been recognized that chronic cough alone can be secondary to asthma. One of the first reports of cough-variant asthma reported on 6 patients whose symptom was persistent cough without wheezing or dyspnea.There was no past history of asthma, and the baseline spirometry was normal. However, bronchial hyperresponsiveness testing was positive, and coughing abated with bronchodilators.

In addition, a cough that begins after a person has begun taking beta-blockers is likely to be cough-variant asthma. Beta-blockers are drugs used to treat high blood pressure, heart disease, heart failure, migraines, palpitations, and other conditions. Beta-blockers are also found in eye drops to treat glaucoma and other eye problems. These eye drops can bring on asthma symptoms, including cough. Asthma and aspirin-sensitivity is another cause of coughing with asthma.

How Is Cough-Variant Asthma Diagnosed?

Cough-variant asthma is somewhat difficult to diagnose because the cough may be the only symptom, and cough itself may appear to be bronchitis or cough associated with postnasal drip.

Cough Variant Asthma Treatment, Causes, Symptoms, Diagnosis

Your health care provider will ask you questions about your medical history and will examine you and listen to you breathe. However, people with cough-variant asthma often have normal physical exams, chest X-rays, and spirometry. Spirometry involves measuring how much air you can exhale after first taking a deep breath, and how quickly you can empty your lungs. The asthma test uses a device called a spirometer to do the measuring.

A methacholine challenge test will indicate asthma, but it may require the use of a special facility. This test may be performed if your symptoms and spirometry test do not clearly show asthma. When inhaled, methacholine causes the airways to spasm and narrow if asthma is present. During this test, you inhale increasing amounts of methacholine aerosol mist before and after spirometry. The methacholine test is considered positive  meaning asthma is present if the lung function drops by at least 20%. A bronchodilator (airway-opening drug) is always given at the end of the test to reverse the effects of the methacholine.

Another way health care providers diagnose cough-variant asthma is by treating the cough with asthma medications. If the cough improves with treatment, you will be diagnosed with cough-variant asthma.

Cough-Variant Asthma treatment

Very often, the first step in treating cough variant asthma is the same as the first step in making the diagnosis. Your doctor may ask you to try a short-term airway relaxer (bronchodilator) such as albuterol (Alupent®, Ventolin®, Xopenex® and others). These medicines are given by inhalers or nebulizers. You can read our Aftercare Instruction onAdministering Inhaled Medications. Please be sure to use these medications exactly as prescribed. We typically prescribe these medicines to be used regularly every four or six hours for a set period of time. This is especially important when we are trying to make a diagnosis of cough variant asthma – if we only use the medicines intermittently, they will not work and we may miss the diagnosis.

Cough Variant Asthma Treatment, Causes, Symptoms, Diagnosis

If the medication works, we have made the diagnosis of cough variant asthma. Your doctor will probably instruct you to keep the inhaler or nebulizer ready to use at the first sign of a cold or cough. Again, be sure that once you start the medication, you continue it on a regular schedule (usually every four or six hours) for a set period of time (often 1-2 weeks). You may also want to keep a “cough diary” for a few months, writing down what was going on just before your child develops a prolonged cough. This can help you and your child identify the triggers and avoid them if possible. It also helps you and your child decide when it’s time to start using the medication. In more severe cases doctors sometimes recommend maintenance medications such as inhaled steroids (FloVent®, Vanceril® and others), or medicines called leukotriene modifiers (Singulair® and others).

Other things you can do to help include running a humidifier in your child’s room. Please be sure to change the water every day to prevent mold from growing in it. If your child develops afever, please let your doctor know. You can use acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) to control fever in children over 3 months. Check with your doctor about using it in younger babies. Fever is not dangerous, but it can make the child uncomfortable. If your child seems comfortable there is no reason to give any medication just for fever.

Many children with cough variant asthma go on to develop more obvious symptoms of regular asthma, such as wheezing. It might be a good idea to read our Aftercare Instruction and Child Health Topic on asthma to get some ideas of what to look for.

Cough Variant Asthma Natural Treatment and Home Remedies

Contact your health care professional before taking any natural herbal compounds for illness. They may interact with medications you may already be taking, and can cause adverse reactions.

Mullein oil:

Also called Grandmother's flannel due to the thick and soft leaves it is derived from, can be found growing just about anywhere. It grows to be about three feet tall and blooms spikes of densely thick yellow flowers. it has been used for centuries for common illnesses, such as diarrhea, hemorrhoids, and respiratory diseases. It reduces coughing and clears bronchial airways of mucous.


Bromelain is a proteolytic enzyme found in pineapples that aids in protein digestion. It is removed from the pineapple and made into oral capsules or tablets. Bromelain reduces swelling, bruising, and inflammation. A study conducted at the University of Connecticut showed that bromelain reduces inflammation in the bronchial airways.


The butterbur plant (Petasites hybridus) can be found in Europe, Asia, and North America. It is another centuries-old remedy commonly used for pain, fever, and spasms. It contains active substances called sesquiterpenes, such as petasin and isopetasin. However, it does contain liver toxic substances called pyrrolizidine alkaloids. These toxic substances are removed during the manufacturing process.

Butterbur has been shown to complement the anti-inflammatory benefits of inhalers, in addition to reducing the incidence of attacks and decreasing asthma symptom


Boswellia (Boswellia serrata) is an herb used by the ancients for thousands of years to treat inflammation. Used three times per day for six weeks is found to be quite beneficial for people with asthma.

Other ways to reduce asthma symptoms include:

  • Biofeedback
  • Weight loss
  • Buteyko Breathing Technique

In addition, increasing your daily fruit and vegetable intake, participating in a few of the martial arts, such as Tai Chi and Qi Gong all work to lessen the number of attacks, and provide for better maintenence.

Other Conditions that Might Be Present with Cough-Variant Asthma

As we mentioned, many children with cough variant asthma turn out to have regular asthma. This is more likely if you have a family history of others with asthma. You will want to work together with your doctor to identify signs and symptoms of regular asthma, and to change the treatment as needed.

Many other things cause children to have a cough. Many children develop a persistent cough following a viral infection such as a cold, sore throat, or the flu. We do not know the exact cause of this kind of cough, and there is no really good treatment for it. You can read our Aftercare Instructions on “post-viral cough.” Some children develop an irritation in their throats or upper airways that causes them to keep coughing to try to get rid of it. The repeated coughing can produce more irritation, making the cough even worse. This can be a very difficult cycle to break. This “irritative cough” is one of the few times that we recommend the use of a powerful cough syrup containing codeine, just for long enough to stop the coughing and break the cycle of irritation. Please never use a codeine-containing cough syrup without checking with your doctor.

In some cases children cough in reaction to stomach acid coming up the esophagus. This condition is called “GE reflux,” “GERD,” or “heartburn” (if there is pain with it). The acid can cause throat or lung irritation and coughing. If you find that your child’s cough is noticeably worse after eating or when first lying down to sleep, or if s/he spits up a lot, your child may have this condition. It is fairly easy to treat with medication.

Pneumonia can cause a persistent cough in children. Pneumonia usually has a fever with it, and children appear tired and ill. Children with pneumonia often spit up mucous or phlegm, though you may not see it in younger children who tend to swallow it. Please call your doctor if you are worried about pneumonia.