Reactive airway disease causes severe coughing

DEAR DR. ROACH >>

My spouse is still suffering from chest congestion, coughing and some laryngitis.

She has never completely recovered from the cold she got in early November. She also had a bad case of COVID last April. Her symptoms have waxed and waned, but now she is wheezing in bed. (Interestingly and maybe relatedly, she got much worse the other morning after I sprayed some spa eucalyptus spray in the shower. Maybe she’s allergic?)

She has had two negative COVID tests this week. I was planning to take her to urgent care to at least get an inhaler or something. Any other thoughts?

DEAR READER >> It is common to get reactive airway disease after respiratory infections from viruses like colds, the flu and especially COVID. Reactive airway disease is essentially asthma. It’s called “reactive” because the airways react to things that they don’t like, including cold or dry air, dust, or other airway irritants (maybe the eucalyptus?). This causes a cough and wheezing.

Asthma is a spectrum. Some few people have severe asthma all the time, but most people with asthma experience mild to moderate lung stress. Some people never have symptoms except for when they’re under severe stress, whether it’s from a recent infection or exercising in the cold.

I think reactive airway disease is the most likely possibility behind this, although it’s certainly possible that she has another virus, whether it’s COVID, flu, respiratory syncytial virus or one of the other circulating respiratory viruses.

She should at least be tested for flu. Polymerase chain reaction (PCR) testing for COVID might be worthwhile, since there is so much COVID circulating right now.

Standard immediate treatment is an albuterol inhaler. Steroid inhalers are also used, but they take a week or two before becoming maximally effective.

The combination of the two is highly effective, and most people get good relief.

There are other options, such as montelukast, which starts working quickly and can be stopped once symptoms go away.