Cough Variant Asthma: Why Am I Still Coughing? - Pulmonology

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Cough variant asthma (CVA) is a form of asthma where the primary symptom is a persistent cough, rather than the more typical wheezing or shortness of breath. This condition can be particularly frustrating for patients, especially when they continue to experience symptoms despite treatment. Based on your situation, it seems that you have undergone a thorough evaluation, including chest X-rays, CT scans, and pulmonary function tests, all of which returned normal results. You were diagnosed with CVA and prescribed Ciclesonide, an inhaled corticosteroid, to help manage your symptoms.

1. Continued Coughing and Misdiagnosis: It is understandable to question whether a misdiagnosis could be at play, especially if you are still experiencing a cough after ten days of treatment. While it is possible for some patients to have atypical presentations of asthma or other underlying conditions that mimic asthma symptoms, the tests you have undergone suggest that CVA is a reasonable diagnosis. However, if your symptoms do not improve, it may be worth discussing with a healthcare provider whether further evaluation is necessary.

2. Inhaler Technique and Dosage: The effectiveness of inhaled medications like Ciclesonide can be significantly influenced by how they are used. It is crucial to ensure that you are using the inhaler correctly, as improper technique can lead to inadequate medication delivery to the lungs. If you are unsure about your technique, consider consulting a healthcare professional or a pharmacist for a demonstration. Additionally, the dosage of 160 mcg once daily is a common starting point, but some patients may require adjustments based on their response. If you feel that the medication is not providing relief, it is essential to discuss this with your doctor, who may consider increasing the dose or adding a bronchodilator for immediate relief.

3. Additional Medications: In some cases, patients with CVA may benefit from the addition of a short-acting bronchodilator (like albuterol) to relieve acute symptoms. This can be particularly helpful if you experience sudden episodes of coughing. Your healthcare provider can guide you on whether this is appropriate for your situation.

4. Imaging Results and Inflammation: The normal results from your X-ray and CT scan suggest that there is no significant structural issue in your lungs or airways. However, it is important to note that these imaging studies do not always detect inflammation or other functional issues that may be present in asthma. If you continue to have symptoms, it may be worthwhile to discuss the possibility of a trial of a different class of medications or further functional testing.

5. Allergies and Post-Nasal Drip: Allergies can indeed exacerbate asthma symptoms, including cough. If you have a history of allergic rhinitis, it is possible that post-nasal drip could be contributing to your cough. Consulting an ear, nose, and throat (ENT) specialist may provide insights into whether your nasal symptoms are affecting your asthma. Allergy testing can also help identify specific triggers, allowing for targeted management strategies.

In summary, while your diagnosis of cough variant asthma seems appropriate given your symptoms and test results, the persistence of your cough warrants further discussion with your healthcare provider. They can help ensure that you are using your inhaler correctly, assess the need for additional medications, and explore potential underlying issues related to allergies or other respiratory conditions. Managing CVA often requires a multifaceted approach, including medication, lifestyle modifications, and sometimes additional therapies to address contributing factors.