‘Textbook’ of frightening coughing spells was not diagnosed immediately

Nancy Welch wasn’t taking any chances. For several weeks this summer, she walked around her house clutching her cellphone, prepared in case she again had to dial 911. The memory of her terrified 13-year-old son racing down the stairs of their Northern Virginia home unable to breathe remained uppermost in her mind.

At night she slept on a blow-up mattress on the floor next to Joseph, the youngest of her three children, jolting awake whenever he gasped for breath and vomited sticky mucus, his lips briefly turning blue. Although her son quickly went back to sleep, Welch, 47, was rigidly alert. She wondered why specialists were unable to agree on a diagnosis, instead performing increasingly invasive and sometimes painful tests that seemed to lead nowhere.

(Owen Freeman/For The Washington Post)

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Welch’s growing unease was augmented by the feeling that she knew what was wrong — a suggestion doctors had either brushed aside or failed to pursue.

“I’m just shocked that these pediatric specialists didn’t have it on their radar,” Welch said. “I’m thinking that if I hadn’t taken him to the ER, I still might not know.”

On July 3, Welch took Joseph for his annual checkup. Other than a slight cough — his mother thought he was getting a cold — he seemed fine. But the pediatrician, who heard the cough, told Welch he suspected asthma and prescribed an inhaler.

“I brought it home but didn’t consider using it,” Welch said. Joseph had never had asthma, and the cough seemed too minor to warrant medicine.

Three mornings later, she was shocked to see Joseph run downstairs, bug-eyed with fear because he was unable to catch his breath. Welch dialed 911 and tried to calm her panicked son — and herself. Paramedics arrived within minutes; after Welch mentioned the newly prescribed inhaler, they helped Joseph take a few puffs and advised that he use it. Within minutes, he was breathing normally.

Mother and son went back to the pediatrician that afternoon. The doctor, who reiterated his belief that Joseph had asthma, added two drugs to the medication regimen: a common antacid for reflux and azithromycin, an antibiotic to be taken for five days. “He didn’t say why he was prescribing them, and my first mistake was not to ask,” Welch said. This time, she had her son use all of the medicines the doctor prescribed.

That night, Welch recalled, her son had two or three coughing episodes. “He’d jump out of bed, cough spasmodically for about 30 seconds, spit out some sticky mucus and go back to sleep.”

Several days later, the pediatrician arranged for Joseph to see a pediatric pulmonologist.

The lung specialist, whose office was an hour away from the family’s home — an ordeal because Joseph gets carsick — concurred with the probable asthma diagnosis. A chest X-ray and a lung function test were both normal.

During that visit, Welch said, Joseph did not cough, although he tried to re-create the high-pitched wheezing, called stridor, which characterized his coughing episodes, as his mother described the sound. The pulmonologist added a second inhaled medicine and advised continuing with the anti-reflux medicine.