Chronic cough

A chronic cough is a common problem resulting in significant impairment of quality of life. Along with cough variant asthma and nasal disease, gastroesophageal reflux is considered one of three main causes of a cough.

But there are other reasons we cough too.

The dreaded Cough


Chronic cough

Relationship between microaspiration, gastroesophageal reflux, and cough frequency

Microaspiration is often considered a potential cause of a cough. The aim of this study was to investigate the relationship between microaspiration, the degree and type of gastroesophageal reflux, and the frequency of coughing in patients with a chronic cough. Proximal gastroesophageal reflux and microaspiration into the airways have limited roles in provoking chronic cough. Indeed, coughing appears to be protective, reducing pepsin concentration in the larger airways of patients with a chronic cough.

GERD-related cough

A chronic cough is a common problem resulting in significant impairment of quality of life. Along with cough variant asthma and nasal disease, gastroesophageal reflux is considered one of three main causes of a cough. Despite this, acid suppression therapy is often far from effective. This review aims to explore whether reflux can lead to a cough, the circumstances in which this is most likely to occur, and the potential mechanisms linking these processes. Particular mechanisms to be explored include laryngopharyngeal reflux, microaspiration, and neuronal cross-organ sensitization. Finally, diagnostic approaches are considered.

Different respiratory diseases associated with a chronic cough create distinct microbial imbalances in the lower airways of children, according to a study led by researchers at NYU School of Medicine. The study, published online this month in Pediatric Pulmonology, is the first to assess the bacterial population of the airway and gastrointestinal systems of children with a chronic cough using bacterial DNA sequencing.

Up to 20% of preschool-aged children experience a recurring cough lasting longer than four weeks. Unlike an acute cough, which typically lasts fewer than two weeks and is frequently associated with a respiratory tract infection, chronic cough is often related to an underlying respiratory or gastrointestinal issue such as asthma, upper airway disorders, or gastroesophageal reflux disease (GERD).

“A chronic cough can have a significant negative impact on a child’s quality of life, and in order to effectively treat it you must accurately identify the cause,” says lead author Mikhail Kazachkov, MD, clinical professor in the Department of Pediatrics and director of the Division of Pediatric Pulmonology at Hassenfeld Children’s Hospital at NYU Langone. “This first-of-its-kind study could improve assessment and treatment for children with a chronic cough by allowing clinicians to better understand the underlying condition.”

In current practice, clinicians collect fluid or tissue samples and enable bacteria from the sample to grow in a dish to gather information about the airway’s bacterial population and make a diagnosis. With this newer method of 16S ribosomal RNA gene sequencing, researchers were able to capture the presence of key bacterial species in the children’s upper and lower airway and digestive system that were missed by the traditional culture method.

“The disparity between the results of the traditional method of testing and the more unbiased DNA sequencing method further highlights our incomplete knowledge of the microbial populations living in the human body,” says senior author Leopoldo N. Segal, MD, assistant professor in NYU Langone’s Division of Pulmonary, Critical Care, and Sleep Medicine.

The study consisted of 36 children seen at the Pediatric Aerodigestive Center at Hassenfeld Children’s Hospital who had suffered from a daily cough for more than eight weeks. Children were assigned to one of four groups after clinical evaluation: asthma, protracted bacterial bronchitis (PBB), neurologically impaired children fed orally, and neurologically impaired children fed through a tube. Neurologically impaired children are more likely to experience respiratory problems due to a condition’s effect on a child’s muscle strength, breathing, and swallowing.


An acquired tracheal diverticulum is a rare clinical entity with only limited reports in the literature. We report a case of a tracheal diverticulum that was identified as part of a work-up for a worsening cough. In this case, the diverticulum was observed 2 years after surgical management of a retropharyngeal abscess. It was felt that pooling of secretions in the acquired pouch was a contributing factor in the exacerbation of the patient’s chronic cough. Because of the patient’s extensive comorbidities, observation and serial computed tomography scans were recommended.


Tracheal diverticulum also referred to as tracheocele, is typically discovered as an incidental finding on a radiograph, on endoscopy, or during a postmortem examination. (1) It is a rare clinical entity with only limited reports in the literature.

Tracheal diverticula can be congenital or acquired. The congenital type is typically small and narrow-mouthed while the acquired type is larger and wide-mouthed. Mounier-Kuhn syndrome, a rare, most likely congenital, the disorder can be mistaken for tracheal diverticulum because it involves dilatation of the trachea and main stem bronchi, with folds of redundant mucosa and fibromuscular tissue that resemble diverticula. (2,3) Acquired diverticula are thought to be outpouchings that occur at weak points in the posterior wall of the trachea in response to increased intraluminal pressure, such as occurs during a cough.

This article describes the discovery of an acquired tracheal diverticulum that was observed 2 years after surgical management of a retropharyngeal abscess.

Case report

An 81-year-old man, a dairy farmer, presented to his primary care physician with a 2-year history of a persistent cough. A cough had been present since he had developed a retropharyngeal abscess that required intubation for airway control and surgical drainage. He had recovered without complication from that procedure, with the exception of a persistent cough and some intermittent swallowing difficulty.

The patient described the frequency and severity of his cough as waxing and waning, and generally nonproductive; he denied any hemoptysis. A cough was typically worse at night when the patient was in bed and in the morning when he first got out of bed. He did report significant gastroesophageal reflux disease (GERD) symptoms and postnasal drip. His medical and surgical histories were significant for hypertension, coronary heart disease with stable exertion angina, coronary artery bypass graft, hyperlipidemia, and mild anemia. He was not taking an angiotensin-converting enzyme inhibitor or any other medication associated with a cough.

Computed tomography (CT) of the patient’s neck and chest revealed an “abnormal, sac-like collection of air along the right lateral posterior aspect of the trachea, at the level of T2 and T3.” The 1.5 x 1.4-cm tracheal diverticulum was located on the right posterior, lateral to the distal trachea (figure). CT also showed findings consistent with interstitial fibrosis and no evidence of retropharyngeal abscess or prevertebral thickening. (The patient’s CT scans that had been obtained 2 years earlier to evaluate his retropharyngeal abscess were reviewed and did not reveal any evidence of a tracheal diverticulum at that time.)

Based on these findings, the patient was referred to our pulmonology and otolaryngology departments at Fletcher Allen Health Care, Burlington, Vt. After complete evaluation and consultation, it was determined that the differential diagnosis for his chronic cough included untreated GERD and postnasal drip, usual interstitial pneumonia, and chronic hypersensitivity pneumonitis with traction bronchiectasis. Although the symptoms related to GERD and postnasal drip completely resolved on maximal medical treatment with proton pump inhibitors and steroid nasal spray, his cough remained unchanged.

The lack of sputum production spoke against bronchiectasis being the cause for this patient’s cough, and the fact that he had chronic hypersensitivity pneumonitis with fibrosis for > 10 years and symptoms for only 2 years argued against either of those conditions being the primary problem. It was agreed that, despite the multiple potential sources of a persistent cough, the tracheal diverticulum was a likely contributor to the problem.

The patient’s cough was refractory to all attempts at medical intervention, including inhalers and improved control of his acid reflux. His case was reviewed in consultation with a group of cardiothoracic surgeons at a nearby academic hospital, none of whom had any experience with this particular finding. They recommended a conservative approach of observation and serial CT scans because of the patient’s extensive comorbidities. The patient has been lost to follow-up.


Tracheal diverticula have been reported to be associated with a chronic cough, recurrent nerve paralysis, and/or cervical neck swelling. (2,4,5) They have also been reported to cause difficult endotracheal intubation with associated pneumomediastinum, as well as ventilation difficulty. (6,7)

The present case demonstrates the identification of a tracheal diverticulum on a CT scan obtained 2 years after surgical drainage of a retropharyngeal abscess. It is unclear whether the infection or endotracheal intubation that took place during the management of the patient’s retropharyngeal abscess was the cause. It seems possible that the intubation weakened the posterior trachea, leading to the development of the diverticulum, and that coughing further contributed to its development. Pooling of secretions in the acquired pouch would explain the exacerbation of the patient’s cough when he was lying down and when he first awoke in the morning.


The choice of treatment for tracheal diverticulum is based on the patient’s age and comorbidities. Surgical resection is typically reserved for the young, while conservative observation and symptomatic treatment are used in the elderly.

Tracheal Diverticulum

What is a tracheal diverticulum?

A tracheal diverticulum is a pouch in the trachea (windpipe). It is often a small piece of esophageal tissue that remains on the trachea after a child undergoes surgical repair of esophageal atresia with tracheoesophageal fistula (EA/TEF). Rarely, a child may be born with a congenital tracheal diverticulum. Left untreated, a tracheal diverticulum can trap secretions, increase the chances of lung infections, lead to recurrent TEF and may lead to a collapse of the trachea.

What are the symptoms of a tracheal diverticulum?

A tracheal diverticulum doesn’t usually have symptoms. However, respiratory secretions can build up in the pouch and become infected, resulting in chronic upper respiratory infections and a chronic cough. When the pouch becomes filled with these secretions, it may also press on surrounding tissue and cause the airway to collapse.

What causes a tracheal diverticulum?

Tracheal diverticula can be congenital. They can also develop following surgery to correct EA/TEF.

How is a tracheal diverticulum diagnosed?

Clinicians typically diagnose tracheal diverticula using a procedure known as a bronchoscopy. This test allows them to examine your child’s trachea with a tool called a bronchoscope.

How is a tracheal diverticulum treated?

If the tracheal diverticulum is causing symptoms of recurrent respiratory infections or is associated with recurrent TEF or with tracheomalacia, clinicians will surgically remove it using techniques aimed at preventing recurrence.

How we care for tracheal diverticula

At Boston Children’s Esophageal and Airway Treatment Center, our surgeons have developed techniques to completely resect (remove) tracheal diverticula to help improve the health of your child’s airway. We provide close monitoring of clinical symptoms and respiratory infections. If indicated, we perform repeat bronchoscopies.

Micro Aspiration

The esophagus and cough: laryngopharyngeal reflux, microaspiration, and vagal reflexes

Gastro-oesophageal reflux disease is generally considered to be one of the commonest causes of a chronic cough, however, randomized controlled trials of proton pump inhibitors have often failed to support this notion. This article reviews the most recent studies investigating the mechanisms thought to link reflux and cough, namely laryngopharyngeal reflux, micro-aspiration and neuronal cross-organ sensitization. How recent evidence might shed light on the failure of acid-suppressing therapies and suggest new approaches to treating reflux-related cough are also discussed.

Click on the No’s for more info

For over 30 years gastro-oesophageal reflux disease (GORD) has been considered to be a cause of a chronic cough, either singly or in association with nasal disease and/or asthma [1]. This was initially based on observational studies and small treatment trials of acid suppressants [234]. However, it is the experience of many clinicians that although some patients with a chronic cough do claim relief from acid-suppressants, the majority do not. One of the difficulties in understanding why this might be the case has been a shortage of high-quality evidence. Indeed a recent Cochrane review of various treatments of GORD (H2 receptor antagonists, proton pump inhibitors, motility agents, fundoplication or conservative treatments) for a chronic cough found that meta-analysis was not possible for most treatments in adults and none in children due to poor trial design and lack of appropriate data [5]. Nonetheless, a number of appropriately designed randomized controlled trials have been completed assessing acid suppression with proton pump inhibitor (PPI) therapy in adults with a chronic cough [6789]. The majority of these trials reported negative findings and an intention-to-treat analysis of the pooled data found no significant difference from placebo control. The reasons for this lack of efficacy of PPI therapy in a chronic cough are unclear but possible explanations include:

Hit the link in the banner for the full report.

Does Fish oil help fight off colds?

( Please ask your Doctors before giving omega fish oil or cod liver oil)

On a Personal Note

I  (Steve Wyles) worked outside in all weathers, for 16 years and I took a high dose of omega 3, tablet, every day, and rarely got a bad standard cold. My own daughter has a very poor immune system, because of her rare condition, but she lives on a high-fat diet to fuel her brain etc and rarely gets a cold. I personally believe this has something to do with her high-fat diet

I cant say this will help your Children. But ask your Doctor’s you never know

Colds are no fun for anyone, but for newborns, any assault on their still-developing immune systems can be dangerous. But moms-to-be can reduce the risk that their little ones will get sick by taking fish oil supplements.

In a study published in Pediatrics, researchers at Emory University and in Mexico report that women taking 400 mg of docosahexaenoic acid (DHA), an omega-3 fatty acid found in fish oil, helped their one-month newborns to fight off more cold symptoms such as coughing, nasal congestion and runny noses than moms who took a placebo. The cold-fighting effect lasted for six months; by that time, the DHA-protected infants experienced about the same amount of cold symptoms as the babies whose mothers did not take DHA, but their symptoms didn’t last as long.

“I wouldn’t want to overplay the benefits, but the findings do suggest some benefits early in life,” says the study’s lead author Usha Ramakrishnan, a professor in the department of global health at Emory University School of Public Health. “This is one of the first studies to look at nutritional interventions during pregnancy and immune function of newborns later on.”



How to Use Cod Liver Oil to Fight Upper Respiratory Inflammation

Click on the underlined RED wording

1. Fish oil relaxes tight air passages.

One of the first things you notice when you get a cold is a tingly sensation in your nostrils, and maybe in the back of your throat. This is quickly followed by irritation and a sensation of tightness. Exercise physiologists at Indiana University have found that taking fish oil relieves tight, constricted breathing passages just as effectively as a nose spray or, in some cases, as an inhaler.

These scientists also found that using both fish oil and a medication has no cumulative benefit in relieving upper respiratory airway constriction, and, of course, you need to be taking fish oil before you come down with the infection. That is, be sure to add fish oil to your supplement routine at the beginning of your colds, flu, or allergy season.

2. Fish oil relieves allergic inflammation.

While many of us ask ourselves the question of whether what we have is a cold or an allergy, the simple fact is, a lot of the time it’s both. Fish oil contains omega-3 essential fatty acids that relieve inflammation caused by allergies.

3. Cod liver oil corrects vitamin D deficiency.

One of the reasons we get colds when the weather gets cooler is that many kinds of rhinoviruses are activated by lower temperatures. Another of the reasons we get colds when the weather gets cooler is that we spend more time in confined spaces with other people who may be infected. And a third reason we get colds when the weather turns cooler is that the days are shorter and our bodies don’t make as much vitamin D.

But that doesn’t mean we need supplemental vitamin D all the time. And I’ll explain what this has to do with fish oil in a moment.

Researchers Dr. John Aloia and Dr. Melissa Li-Ng at the Winthrop University Hospital in Mineola, New York tracked patients who took no supplemental vitamin D, 800 IU of supplemental vitamin D daily, and 2000 IU of supplemental vitamin D daily throughout an entire year. They found that the participants in their study who took no supplemental vitamin D at all reported 25 days during the winter when they felt symptoms of colds or flu.

The researchers found that study participants who took 800 IU of vitamin D a day reported just 3 days during the winter when they felt colds or flu, and that those who took 2000 IU of vitamin D a day didn’t have any colds or flu days at all during winter months. Aloia and Li-Ng, however, did not just study the effects of vitamin D during the winter. They also tracked their patients during the spring, summer, and fall.

People who didn’t take any vitamin D at all tended to have a few “cold and flu days” during every season of the year. People who took 800 IU of vitamin D a day had just 1 or 2 days with symptoms during every 3-month period. People who took 2000 IU of vitamin D a day didn’t have any colds or flu during the winter, spring, or fall, but tended to have 1 or 2 days with symptoms in the summer.

This study suggests that vitamin D protects against colds and flu, but it may be possible to get too much as well as too little. I don’t recommend anyone take vitamin D for colds and flu prevention during the summer. Taking vitamin D during cool-weather seasons is enough.

But what does that have to do with fish oil?

Cod liver oil is a great source of both omega-3 essential fatty acids and vitamin D. It is an easy way to get both the omega-3’s that fight inflammation and the vitamin D that fights infection.

Fish oil typically does not contain vitamin D, and shark liver oil contains a lot of substances you just don’t want to take into your body. Cod liver oil, in capsules, is the easiest way to get both omega-3’s and vitamin D in a single dose, nine months of the year.

Nowadays, cod liver oil doesn’t taste bad. You can still buy a big bottle of liquid cod liver oil, and some companies, like Green Pasture, offer excellent prices for cod liver oil in bulk. Chances are, however, that you and your family would prefer cod liver oil capsules like those made by Nordic Naturals for use by the entire family throughout autumn, winter, and spring.

You’ll catch fewer colds outside the home, and there will be less sharing of colds and flu through the family, due to the generous provision of vitamin D. Just be sure to take enough cod liver oil to get 2,000 IU of vitamin D a day for adults, or 1,000 IU per day for children.


Kick Colds Fast With A Detox Bath.

If you want to be prepared for a new flu season, then I have an amazing tip for you: How To Kick Colds Fast With A Detox Bath.

After several years of learning about natural remedies, a good detox bath is one of my favorite ways of kicking a cold fast. Taking a detox bath will help your kids relax, clean their systems of toxins, and absorb wonderful minerals that will strengthen their immune systems.

After a full day of activities, your kids are feeling miserable because of a cold. They are cracky, congested, irritable and just a mess. How To Kick Colds Fast With a Detox Bath is the perfect way to make your kids feel better and relaxed when they are sick. In my experience, it really helps.

A few weeks ago, my 5-year-old son caught a cold. The same day he started to show cold symptoms, I made sure to give him a detox bath. He slept for 12 hours straight afterwards! He woke up the following morning feeling much better. This is when I realized I had to write a post about detox baths.

Your kids are exposed to a lot of toxins from pollution, household cleaners, and processed foods that are full of chemicals and additives. A detox bath with magnesium has the power to eliminate those toxins. So it is also a good idea to just give your kids a detox bath once a week, even if they are not sick to keep their immune systems strong and free of toxins.

I try to take a detox bath once a week too. It is so relaxing and I feel completely rested and energized the following day. If you want to learn all about detox baths and why you should take them, please see this wonderful article HERE. It explains in depth all the wonderful benefits of taking a detox bath.

Studies have shown that magnesium and sulfate are both readily absorbed through the skin, making Epsom salt baths an easy and ideal way to enjoy the associated health benefits. Magnesium plays a number of roles in the body including regulating the activity of over 325 enzymes, reducing inflammation, helping muscle and nerve function, and helping to prevent artery hardening. Sulfates help improve the absorption of nutrients, flush toxins, and help ease migraine headaches.

A substance isolated from the skin of a frog can potently destroy influenza virus particles, scientists in the US have discovered. Appropriately dubbed urumin, after the Indian word “urumi“, which means a whip-like sword, the new agent slices, dices and deactivates flu.

Four of the chemicals potently destroyed flu, although three of them were also highly toxic to human cells. But one of the agents – urumin – which comprises a string of 27 amino acid building blocks, showed powerful anti-flu activity but was also apparently harmless at the same dose to human blood cells. The Emory team tested the substance against 12 different flu strains representing the common circulating types of the virus, including 8 forms of H1N1 and 4 isolates of H3N2 collected during the last 75 years of flu circulation.

While only marginally effective against H3N2 viruses, urumin nevertheless produced a 60-90% inhibition of the growth of all 8 strains of H1N1. Mice given a lethal dose of flu followed by an intranasal dose of urumin were significantly protected, with 70% of the animals surviving compared with 20% of controls. Studies on the animal’s lungs also showed that treated mice subsequently had 80-90% lower virus activity in their respiratory tissues compared with untreated mice.

At the moment the researchers do not know precisely how urumin works, but microscope studies show that contact causes viral particles to disintegrate. The peptide binds to part of the viral coat known as the HA in a region that is very heavily conserved across time, as evidenced by the fact that even viruses that were infecting people 75 years ago remain susceptible to its effects.

This broad spectrum of activity, say the researchers in their paper published in the journal Immunity this week, means that urumin “therefore has the potential to contribute to first-line antiviral treatments during influenza outbreaks.”

For more info click on the banner above

Possible New Drug for bronchitis, and CF

A new treatment for Pseudomonas aeruginosa infection in patients with lung diseases such as cystic fibrosis (CF) and non-cystic fibrosis bronchitis, will be evaluated in an open-label Phase 1/2 clinical trial.

Released April 11th, 2017


Bronchiectasis is an abnormal and irreversible dilation of the airways of the lung. (Click here to find out about Symptoms) typically include a chronic cough with mucus, shortness of breath, coughing up blood, and chest pain. Those with the disease often get frequent lung infections, including those caused by the Pseudomonas aeruginosa pathogen.

March 9th, 2016

The causes of bronchiectasis are often unclear, but the disorder can be due to inherited conditions, inhaled objects, and severe lung infections. Bronchiectasis patients are known to have an increased risk for bacterial infections.

The scientists, led by first author Sermin Borekci, studied 121 patients between 1996 and 2013 who had noncystic fibrosis bronchiectasis. The investigators accessed already-collected information in what is known as a retrospective study. They examined images of the lungs that had been taken using either high-resolution computed tomography (CT) or multi-slice CT. The team further evaluated bacterial cultures that had been taken from the patients.  Pseudomonas aeruginosa in 25 patients (20.6 percent) and Haemophilus influenza in 14 patients (11.5 percent). The presence of either of these bacteria caused a low forced vital capacity (FVC) and the presence of cystic bronchiectasis. Cystic bronchiectasis is the most severe form of the disease.

There are two main types of chest infection: Acute bronchitis is an infection of the large airways in the lungs (bronchi). Acute bronchitis is common and is often due to a viral infection. Infection with a germ (bacterium) is a less common cause. See the separate article called Acute Bronchitis. What is acute bronchitis and what are the symptoms?

Pneumonia is an inflammation in the tiny air sacs of the lung, called “alveoli”, and most commonly caused by a viral, bacterial, or fungal infection. With millions of patients being hospitalized for this ailment each year it is essential to understand the disease and its symptoms, both for yourself and to recognize in others.

The illness normally puts the patient down for the count with no activity for at least a week. It’s a pretty debilitating ailment that literally forces you to rest and lay down for days. It’s spread by contact through air particles, and often totally unrecognizable if you come into contact with someone that you only presume has a cold. Some patients require hospitalization for the lung sickness, and it is incredibly common for those over the age of 60 years old to develop pneumonia easily.

An important tool in the quest to stay healthy is acknowledging when your body is displaying symptoms of distress and what they mean. Pneumonia presents itself with a number of symptoms and indicators, which one may observe both at the onset of infection, and as the ailment progresses.

Here are the 10 signs and symptoms of pneumonia:

Chronic cough

Roughly a quarter to a third of people with EA are diagnosed with asthma. Asthma is tricky to diagnose in EA patients, as both tracheomalacia and aspiration can cause narrowing of the bronchi and wheezing. These conditions should be ruled out before a diagnosis of asthma is made, as persistent aspiration can lead to lung damage. An important clue that wheezing in an EA patient isn’t due to asthma is those bronchodilator inhalers (such as salbutamol) rapidly improve wheezing in people with asthma, but have no effect in people with tracheomalacia – or make the wheezing worse. In people with EA, breathing tests can be performed in individuals 6 years of age and older, to evaluate these issues further.

Why EA patients may be more prone to asthma is an area of controversy. Some studies suggest that asthma in EA patients is linked to allergies, just like in other people with asthma. On the other hand, many experts believe that increased bronchial inflammation early in life, due to repeated aspiration, increases the risk of persistently inflamed airways later in life, resulting in asthma.

Given the many issues that can harm the lungs early in life in EA patients, many studies have looked at lung function in older EA children and adults. On average, lung function is normal, but towards the lower end of the normal range. About 1/3 of EA patients have completely normal lung function. About a third have narrower airways than the average, and about a third have somewhat smaller lungs than the average. Fortunately, exercise capacity is usually normal.

What Causes Asthma?

The exact cause of asthma isn’t known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include:

An inherited tendency to develop allergies called atopy (AT-o-pe)

Parents who have asthma

Certain respiratory infections during childhood

Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing

If asthma or atopy runs in your family, exposure to irritants (for example, tobacco smoke) may make your airways more reactive to substances in the air. Some factors may be more likely to cause asthma in some people than in others. Researchers continue to explore what causes asthma.

The “Hygiene Hypothesis”

One theory researchers have for what causes asthma is the “hygiene hypothesis.” They believe that our Western lifestyle—with its emphasis on hygiene and sanitation—has resulted in changes in our living conditions and an overall decline in infections in early childhood. Many young children no longer have the same types of environmental exposures and infections as children did in the past. This affects the way that young children’s immune systems develop during very early childhood, and it may increase their risk for atopy and asthma. This is especially true for children who have close family members with one or both of these conditions.

Hard to Breathe: NHLBI Researchers Seek Treatments for Severe Asthma

The National Heart, Lung, and Blood Institute, part of the National Institutes of Health, is researching potential treatments for severe asthma. This video features an interview with Dr Stewart Lavine, an NHLBI researcher, who is conducting a clinical study to test new treatment options for patients who live with severe asthma. While 25 million Americans live with asthma, about 1.25 million of those individuals have severe asthma, a condition that can be difficult to control and treat.

Learn more about his research by visiting the NHLBI Laboratory of Asthma and Lung Inflammation website:


Who Is at Risk for Asthma?

Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.

Young children who often wheeze and have respiratory infections—as well as certain other risk factors—are at highest risk of developing asthma that continues beyond 6 years of age. The other risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma.

Among children, more boys have asthma than girls. But among adults, more women have the disease than men. It’s not clear whether or how sex and sex hormones play a role in causing asthma. Most, but not all, people who have asthma have allergies.

What Are the Signs and Symptoms of Asthma?

How Is Asthma Diagnosed?

How Is Asthma Treated and Controlled?

How to use Asthma inhaler, watch this short video on how to do it right.

Asthma how-to: How to use an inhaler with a spacer and mask

How to treat a child having an asthma attack


What is Spirometry?

Spirometry is a simple test used to help diagnose and monitor certain lung conditions by measuring how much air you can breathe out in one forced breath.

It’s carried out using a device called a spirometer, which is a small machine attached by a cable to a mouthpiece. Spirometry may be performed by a nurse or doctor at your GP surgery, or it may be carried out during a short visit to a hospital or clinic.


Spirometry is the first and most commonly done lung function test. It measures how much and how quickly you can move air out of your lungs. For this test, you breathe into a mouthpiece attached to a recording device (spirometer). The information collected by the spirometer may be printed out on a chart called a spirogram.

The more common lung function values measured with spirometry are:

Understanding Your Breathing



Common Variable Immune Deficiency

Common variable immune deficiency (CVID) is a disorder that impairs the immune system. People with CVID are highly susceptible to infection from foreign invaders such as bacteria, or more rarely, viruses and often develop recurrent infections, particularly in the lungs, sinuses, and ears. Pneumonia is common in people with CVID. Over time, recurrent infections can lead to chronic lung disease. Affected individuals may also experience infection or inflammation of the gastrointestinal tract, which can cause diarrhea and weight loss.

Causes of Stridor and Wheeze (Breathing Sounds)

Stridor and wheezing are two terms for different breathing sounds that are often used synonymously although there is a difference. Wheezing refers to the high-pitched or whistling sound, which is most prominent when breathing out (expiration). A wheeze is usually heard clearly upon auscultation (use of a stethoscope) although at times it may be audible, especially to the patient, without any need for a stethoscope. A stridor is also high pitched but ‘rough’ sound sometimes described as crowing. It easily audible without the use of a stethoscope (auscultation) and while it is present when breathing in (inspiration) or out (expiration), it is usually more prominent on inspiration.

The respiratory system is made up of the organs that allow ventilation, which is the entrance and exit of gas or air passages, and the lungs, which is responsible for gas exchange between the air and the blood. Starting from the nose, air travels through the nasal cavity, into the pharynx, larynx, and trachea (air or windpipe). Here the air will diverge into the two bronchi, each of which divides multiple times to form bronchioles that empty air into the air sacs (alveoli) of the lungs. The tracheobronchial tree is a series of ‘tubes’ that lead to the lungs. These tubes are thin-walled, lined with membranes that secrete mucus, and contain smooth muscle in the wall. Under certain conditions, the membranes may produce more mucus, the smooth muscle may contract or the wall of the tubes may become inflamed resulting in swelling. All these mechanisms will cause constriction (narrowing) of the tubes to varying degrees thereby affecting the flow of air. However any mass within the airways, whether a foreign body, abscess or tumor will also affect the passage of the air. The disrupted airflow is often the reason for abnormal breathing sounds like a wheeze or stridor, similar to the changes in the flow of air through a flute.

Baby with Croup Stridor Barking Cough visual & audio sound

Uploaded on Apr 14, 2011

My 2-year-old daughter at rest in bed with Croup – presenting with a barking cough, stridor and distressed breathing and depressions in the chest. These all together at rest are indications for you to seek medical attention for your child.
My daughter was under prescription inhalers and we had a nurse monitoring her during the filming of this video. Never be afraid to call for help.

other links


Croup is a type of upper respiratory infection that causes a bark-like cough. The condition most commonly affects children and does not usually cause complications. Croup is a breathing problem medically called Laryngotracheobronchitis. It caused by viral infection, allergy, bacterial infection, and acid reflux.

However, in rare cases, croup can become serious enough to block the airways and prevent normal breathing. Croup symptoms usually last no longer than five days and resemble cold-like symptoms when the infection first begins. Symptoms caused by the condition are the result of inflammation of or around the vocal cords and windpipe.

It starts as a mild cough and gradually turns severe and sounds like a seal barking. The child may not be able to sleep properly at night with shortness of breath. Unfortunately, croup symptoms are often worse at night and are easily made worse by crying, fussiness and coughing, which can make the condition very difficult to deal with for both you and your child. Fortunately, however, croup infection typically clears on its own in a matter of days and requires no treatment unless the child is having persistent breathing troubles. During the course of a croup infection, the most effective treatment is to make your child comfortable and calm to prevent excessive coughing. Encourage the child to sleep often and keep them hydrated. Because of inflammation of the airways, the child may make a noticeable whistling noise when taking in air. In some cases, croup may also be accompanied by fever, sore throat and hoarseness.

Treatment is given based on the intensity of the disease. It can be managed by home remedies if it is a mild cough. Do not give cough medications without consulting your doctor. In case of breathing difficulty, the doctor may want to hospitalize the child for putting him on artificial respiration. (Worse case) as there might be swelling in the upper respiratory tract.

If you have older children, offer them foods that will ease their sore throat, like something cold, or warm like soup or a ice cream. It may also help their breathing if they sit in an upright position, you might need to hold them. Do not hesitate to see your child’s doctor if their croup symptoms become worse, remember your child has to come first. However, if your child has severe croup, they will need to be admitted to hospital urgently.

Treating croup

Treatment of croup depends on how severe the symptoms are. Most cases are mild and can be managed at home.

Treatment at home

If your GP thinks your child has mild croup, they will usually recommend managing it at home. This will often involve using children’s paracetamol to ease any pain associated with the condition and may help lower your child’s temperature if they have a fever. You should also ensure your child is well hydrated by encouraging them to drink plenty of fluids. Comforting your child is also important because their symptoms may get worse if they are agitated or crying. If your child is distressed, sitting them upright on your lap will help to comfort and reassure them.

Your GP UK will usually prescribe a single dose of an oral corticosteroid medication called dexamethasone or prednisolone to help reduce swelling (inflammation) in your child’s throat. Side effects of these medications can include restlessness, vomiting, upset stomach and headache.

Steam treatment is not advised for the treatment of croup. There is no evidence that allowing your child to breathe in humid air, for example, steam from a hot bath or shower in a closed room will help. You should seek urgent medical advice if you notice your child’s symptoms getting worse.


Chronic cough

Bronchitis – acute

Acute bronchitis is swelling and inflammation in the main passages that carry air to the lungs. The swelling narrows the airways, which makes it harder to breathe. Another symptom of bronchitis is a cough. Acute means the symptoms have been present only for a short time.

Bronchitis is an inflammation of the airways in the lungs. The main tubes that air flows through in the lungs are called bronchi, and branching off them are smaller tubes called bronchioles. When these tubes become inflamed it causes narrowing, constriction, and blockage of the airways, which leads to symptoms of bronchitis. Bronchitis can be acute, lasting less than six weeks, or chronic.


Newborn making abnormal sounds while breathing? Watch out, for it may be a case of Laryngomalacia that is the actual cause. Read and know all about the causes, symptoms, diagnosis and treatment options for this disorder.

Laryngomalacia Definition

It is a congenital malformation of the laryngeal cartilage, meaning it is present at birth. However, it is not a serious condition in the majority of cases.

This anomaly of the larynx is also referred to as “Soft Voice Box” or “Soft Larynx.”

Laryngomalacia ICD9 Code

The ICD9 Code for this disease is 748.3.

Who Suffers from Laryngomalacia?

The condition is quite common in infants and young children although it may also arise in some adults. Older adults, particularly those suffering from weakened throat muscles due to neuromuscular disorders, can suffer from this disease. However, the disorder is much more common in infants.

Laryngomalacia Symptoms

A person affected by this disorder tends to make abnormal noises, especially a whistling sound (stridor) while breathing. Stridor refers to a high-pitched noise that can be heard when a child breathes in (inspires). It can sound like snoring through a congested nose or high-pitched squeaking. In some cases, the sound is audible to anyone present near the sufferer. In the rest of cases, the noise can be heard only with the help of a stethoscope.

Picture 1 – Laryngomalacia

In some infants, the area at the throat base can be found to sink in with inspiration. In others, the region under the diaphragm is observed to drop.

While stridor is mainly audible during the inspiration of infants, it can also be heard at the time of expiration (breathing out).

Some other features of the condition include:


The trachea, commonly known as the windpipe, is a tube about 4 inches long and less than an inch in diameter in most people. The trachea begins just under the larynx (voice box) and runs down behind the breastbone (sternum). The trachea then divides into two smaller tubes called bronchi: one bronchus for each lung. The trachea is composed of about 20 rings of tough cartilage. The back part of each ring is made of muscle and connective tissue. Moist, smooth tissue called mucosa lines the inside of the trachea. The trachea widens and lengthens slightly with each breath in, returning to its resting size with each breath out.

Chest infections are very common, especially in autumn and winter. Chest infections can be serious and need urgent treatment. However, many chest infections in otherwise healthy people do not need antibiotic medicines and get better quite quickly. If you feel very unwell then you should see a doctor urgently to see what treatment you need.

There is a Page on this website with more on this, with videos and more.

Tracheomalacia (TM) is a disorder of the airway consisting of a weakness of the anterior tracheal cartilaginous rings and laxity of the posterior membranous trachea, resulting in dynamic airway obstruction. The clinical symptoms range from a chronic cough and wheezing.

Tracheomalacia is a very rare condition that occurs when the cartilage that forms the walls of the windpipe, which is normally rigid, becomes weak and floppy. The condition is usually congenital, appearing at birth because the cartilage has not developed properly. In some cases, it is acquired when the weakening develops after birth. It causes a variety of respiratory complications and, left untreated, the breathing difficulties can increase to the point of requiring urgent or emergency care. Often, tracheomalacia is associated with oesophagal atresia (a blockage of the oesophagus) and tracheoesophageal fistula (an opening between the trachea and the oesophagus) but may occur without other conditions. Patients with tracheomalacia who develop respiratory infections should be monitored closely by their healthcare provider.

What Causes Tracheomalacia?

Some babies are born with the cartilage of the trachea being weak, known as congenital tracheomalacia. A breakdown of the windpipe cartilage after birth is referred to as acquired, or secondary, tracheomalacia. It may occur as a result of large blood vessels putting pressure on the airway, complications from surgery for tracheal-esophageal fistula or oesophagal atresia, or from extended use of a breathing tube.

Kartagener syndrome

What is Kartagener Syndrome?

A Rare Inherited Disorder, Kartaganer Syndrome Causes Respiratory Issues