Understanding Cough Variant Asthma and Using Albuterol for Your 5-Year-Old
Cough variant asthma is a type of asthma where persistent coughing is the main symptom instead of wheezing, and it responds well to asthma medications including albuterol (a rescue inhaler) used with a spacer device. 1
What is Cough Variant Asthma?
Your child has a form of asthma where the airways are irritated and inflamed, but instead of causing wheezing, it causes a persistent dry cough. 2 This cough can be triggered by:
- Viral infections (like colds) 1
- Exercise or excitement 1
- Cigarette smoke exposure 1
- Allergens like pets, pollen, or dust 1
- Cold air or weather changes 1
The cough may be worse at night and can interfere with sleep, school, and play activities. 1 Unlike typical asthma, your child may have minimal or no wheezing. 2
How to Use Albuterol Properly
Equipment You Need
Always use a metered-dose inhaler (MDI) with a valved holding chamber (spacer) - never use the inhaler alone, as 5-year-olds cannot coordinate the breathing technique needed without a spacer. 1
Step-by-Step Instructions
For mild to moderate symptoms, give 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed. 3 Here's how:
- Shake the inhaler well 1
- Attach the inhaler to the spacer 1
- Press the inhaler once to release one puff into the spacer 1
- Have your child breathe in that one puff through the spacer 1
- Wait a moment, then press the inhaler again for the second puff 1
- Have your child breathe in the second puff 1
- Continue until you've given the appropriate number of puffs 1
Important: Give one puff at a time into the spacer, let your child breathe it in, then give the next puff - do not spray multiple puffs into the spacer at once. 1
When to Use Albuterol
Albuterol is a "rescue" or "relief" medication for acute symptoms - it opens the airways quickly but doesn't treat the underlying inflammation. 1, 4
- Use it when your child has coughing episodes 1
- Use it before exercise if exercise triggers coughing 1
- Effects begin within 5 minutes and last 3-6 hours 4
Critical Warning Signs
If your child needs albuterol more than twice per week (not counting before exercise), this means the asthma is not well controlled and you need to contact your doctor immediately. 3 This indicates your child likely needs daily controller medication (like inhaled steroids) to prevent symptoms. 1, 3
Seek immediate medical care if: 1
- Symptoms don't improve or worsen after albuterol 1
- Your child needs albuterol every 2-4 hours 1
- Your child has difficulty breathing or speaking 1
- Lips or fingernails turn blue 1
Long-Term Management
Most children with cough variant asthma need daily inhaled corticosteroids (preventive medicine) to control the underlying inflammation, not just albuterol for symptoms. 2 Research shows that inhaled steroids effectively control cough variant asthma long-term. 2
Goals of Good Asthma Control
Your child should: 1
- Have minimal coughing during the day 1
- Sleep through the night without coughing 1
- Not miss school due to coughing 1
- Participate fully in sports and activities 1
- Need albuterol infrequently (less than twice weekly) 1, 3
Environmental Control
Reducing triggers is essential: 1
- Most important: Eliminate cigarette smoke exposure - this is the single most important environmental factor 1
- Minimize exposure to known allergens 1
- Treat viral infections promptly 1
Common Pitfalls to Avoid
Do not rely solely on albuterol without addressing the underlying inflammation with controller medications if symptoms are frequent. 3 Overuse of rescue medication without proper controller therapy is a common mistake. 3
Do not use the inhaler without a spacer - your child cannot coordinate the breathing technique properly at this age, and most of the medication will be wasted. 1
Do not delay seeking medical attention if symptoms worsen or don't respond to albuterol - this could indicate a severe exacerbation requiring additional treatment. 1