Cough variant asthma symptoms and conditions

I am a part-time professional singer and attorney. I developed an odd cough-variant asthma this winter at age 42 -- it had scary breath shortness and wheezing plus lots of phlegm coughed up. I had never before had the shortness/wheezing/asthma, though I have always had allergies and occasional bronchitis following a cold. The asthma/allergy specialists put me on Advair 500 twice a day with each attack, plus an oral prednisone burst/short taper, nebulized (not just rescue inhaler) albuterol (beta 2 agonist), and antibiotics (a different one each time). I also take Claritin, Rhinocort and Astelin for my allergies. I had four attacks of asthma this winter that were treated this way; after the fourth, they put me on Advair 250 maintenance for a month. With each attack, I would get hoarse, have trouble sleeping, and get odd muscle cramps I never had had. The hoarseness was worse each time, but I was able to sing through it at my regular gigs. I attributed the side effects to the prednisone. With my fifth attack, they told me to ramp up the Advair to 500 and do all else the same, but as an experiment to see how this would alter those side effects, I decided to treat it with everything but the prednisone. The hoarseness, sleep trouble, and muscle cramps were all much worse. I found this site, noted the recommendation of several other singers to try Asmanex instead of Advair, and asked the docs about it. They agreed that all these symptoms could be related to the Advair and gave me Asmanex 250 twice/day instead instead of the Advair, plus all the other meds for the attack. The symptoms went away within a week, although it took a little longer for me to get over the asthma attack this time. I am extremely grateful to this site and all the users posting comments. I can sing again, sleep again, and exist without weird muscle cramps during treatment of my asthma. Thank you very much.

Our son started taking Singulair when he was 2 for severe allergic rhinitis and cough variant asthma (in addition to Zyrtec, which didn’t control all of his symptoms). He is 5 now. For the last three years, he has been an increasingly violent, difficult, defiant, argumentative, volatile child who has intense mood swings--one minute he’s laughing uncontrollably, the next he’s weeping over nothing. His doctor and therapist recommended that we see a psychiatrist to have him evaluated for bipolar disorder, which used to be unknown in children. Because he has such chronic sleep problems, the doctor also suggested we take him off Singulair (and increase his Zyrtec dose) to see if it improved his sleep issues. Within a week, he was sleeping much better and was a calmer, happier, gentler boy. He suddenly could take “no” for an answer without flipping out and trying to hurt me. We thought that we were just in an unusual, calm window that would shift either to mania or intense sadness or both, any minute. We also thought that his behavior change might be due to sleeping better. We were enjoying the rare reprieve. Over the last weekend, his springtime allergies really flared up. We gave him Singulair on Monday and by noon, he was completely out of control. I had to strap him into his car seat at one point to keep him from hurting either me or himself. It finally occurred to me that Singulair might be causing his “bipolar” disorder. Of course, we stopped the Singulair. After two days he was a new boy. Yesterday, I Googled “Singulair bipolar children” and got a few hits. I am stunned to read how similar other families’ experiences have been to ours and I feel sick that we gave this drug to our child for three years.

Effective after two weeks for some people - not effective for others. Side effects for some people - others do not report side effects. So why does Merck have to grow their market before they have any idea what's going on?

This isn't a big group of people in the study but it makes sense from what we are reading here. These researchers did examine the mast cells. We need to know about mast cells (while suppressed by montelukast) on a longer term basis.

J Asthma. 2008 Apr;45(3):243-50. Links
The efficacy of montelukast and airway mast cell profiles in patients with cough variant asthma.Kawai S, Baba K, Matsubara A, Shiono H, Okada T, Yamaguchi E.
Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi, Japan.

Background. Cough variant asthma (CVA) is characterized by chronic cough without apparent wheezing; its pathophysiology is considered to be similar to that of classic asthma. Objective. The clinical effects of montelukast, a cysteinyl-leukotriene receptor antagonist, on cough variant asthma were assessed, and the activation profile of airway mast cells was examined. Methods. Montelukast (10 mg/day) was given orally to 36 CVA patients (25 women and 11 men; median age, 37.5 years). Before treatment, the patients' bronchial mucosa underwent a biopsy with a fiberoptic bronchoscope. The biopsy specimens were double stained with anti-CD63 antibody and anti-human tryptase antibody. Results. After 2 weeks of montelukast treatment, cough symptoms improved in 22 patients (the effective group) but did not improve in 14 patients (the ineffective group); in the ineffective group, the symptoms disappeared 2 weeks after they were switched to fluticasone propionate (400 mug/day) inhalation therapy. In the effective group, the time interval from the onset of symptoms to the initiation of treatment was significantly shorter than in the ineffective group. The bronchial mucosa biopsy specimens showed that the proportion of CD63-positive cells in tryptase-positive mast cells was significantly higher in the effective group than in the ineffective group; although the total numbers of mast cells were not different between the two groups. Conclusion. There is a subgroup of CVA patients in whom leukotrienes are closely involved in the pathogenesis of their chronic cough; activation of airway mast cells may be an essential feature in these patients.

PMID: 18415834

I have been on pred for 11 days. 20mg twice a day for cough-variant asthma. I can tell the coughing is getting better but I am in a lot of pain that just started in my (both) knees. I am not sure why this is happening, it is almost like I can not walk with out fear of falling. I am 50 years old. I plan to call my doctor first thing in the am and try to get off this as soon as I can. My knees are killing me, has anyone else ever had this happen and if so does it go away with pain medication?

I am a 39 year old woman who switched from Azmacort to Advair in December for a few weeks. After that short of time, I felt me throat feel like it was closing up, I was agitated, and one morning after a week of building symptoms, took my blood pressure which was 20 pts higher than usual. I also had burning in my chest and felt on the verge of a panic attack. Since then I was prescribed Pulmicort, and it has been so much better.

I also accessed this site mainly because of my son who is 6. He was diagnosed with cough variant asthma and some allergy to outdoor mold. The doctor started him on Advair, and over the last month or so, the behavior change has been startling. He has been very agitated, clearing his throat constantly, wetting the bed, saying he was"scared" at bedtime, saying he was "happy on the outside but sad on the inside", and being so hyperactive and inattentive as to be staring right at him when telling him something, and he would totally go off and do what you just told him not to, and be genuinely confused as to why he was in time out.

I have an appointment tomorrow morning with the allergist and have had him off of advair for four days. Already the throat clearing has stopped and the behavior has subsided. I am also hoping to keep him off of singulair as well after hearing about those side effects and see if we can manage for now. Thanks for all of the helpful info and we will see.