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Column originally published Dec 15, 2009

It Is Not Easy To Diagnose Whooping Cough

Question: Our five-year-old son has a really bad cough for the past two weeks. He started out with a cold and some cough. He has asthma, and I thought it was one of those episodes which we are very familiar with. We gave him his puffers, but he didnʼt get any better. Instead, he is a lot worse in the last few days. He coughed to the point of turning red in his face and losing his breath. My good friend said that he sounds exactly the same as when she had whooping cough as a child. I did take him to see our family doctor, but she said that he has a bad cold, and to continue with his puffers. Our two-year-old daughter is starting to cough now. I am really scared. I donʼt think they caught the H1N1 infection because they both got the vaccine, and they donʼt have influenza-like symptoms that I have read about. Should I bring him back to my doctor and ask about whooping cough?


From the brief description that you gave, it is very possible that your son does have whooping cough, and your younger daughter may have caught the infection from him, and she is starting to get sick also.

Whooping cough is caused by a germ called Bordetella pertussis. It is easily spread from person to person, not just kids to kids, but also kids to adults, and then adults to other children.

When children get infected with the whooping cough bacteria, they are not very sick at the beginning. They have symptoms of a mild cold, with some running nose, a little fever, and cough. Instead of getting better after a few days, the cough gradually gets much worse. Many have cough spasms and cannot catch their breath when they are coughing. As a result, the face turns red and sometimes even a little dusky. Some can cough to the point of vomiting, and the cough spasm may end with a ʻwhoopʼ noise: that is why this illness is called whooping cough.

These cough spasms can last for many weeks. Very small children may not able to eat and lose weight. If their face turns dusky, they may not have enough oxygen, which can be dangerous. Some small infants can suffer brain hemorrhage and die because of severe whooping cough. This is the reason why whooping cough vaccine is given to all children beginning at two months of age. However, like most vaccines, it is not perfect. Furthermore, the immunity against whooping cough doesnʼt last as long as we want.

Older children and adults gradually lose their immunity against whooping cough. This is the reason why we still see outbreaks of the disease every few years. Adults usually do not have the typical symptoms. Instead, they just have bad cough that can last for months, and are often incorrectly diagnosed as chronic bronchitis.

Because almost all children are immunized with this vaccine, whooping cough is not a common illness any more. As a result, many doctors have never seen children with whooping cough. For someone like your friend who had it as a child, she would recognize the cough because of her own experience. Unless your doctor can hear the severe cough spasms, or see your sonʼs face turning red or dusky, she may not be able to determine the diagnosis. There is usually no abnormal finding in listening to the chest.

Chest X-ray is also not useful. Taking a secretion from the nose to test for whooping cough bacteria can help to confirm the diagnosis, even after a person has been treated with antibiotics.

Since your son has asthma, his cough will get much worse when he is infected with whooping cough. As you have already experienced, treating him with his regular doses of puffers wonʼt work very well if he has whooping cough.

There are antibiotics that your doctor can prescribe which are effective to kill the bacteria. If they are given early in the course of the illness, they can decrease the severity and duration of whooping cough. If they are given later, they can still kill the bacteria so that your son wonʼt spread the germs to others, although they may not decrease his cough spasms.

Because we have H1N1 influenza pandemic going on right now, I should mention that there is quite a bit of difference between H1N1 infection and whooping cough. Those who are infected with H1N1 often have high fever, headache, body ache, nausea, and no energy. They almost always have cough, and pneumonia can set in quickly. Most people donʼt get very sick, but if they do, they usually get very sick very quickly. They have to go to emergency room and may need intensive care as well as antivirus medicine to kill the H1N1 virus.

Those who get infected with whooping cough get sick rather slowly. They usually start with cold-like symptoms, and their cough gets worse after several days to weeks. Their cough sounds much worse than what their doctor can hear in the lungs.

I hope you have a better understanding about whooping cough now. I would encourage you to take both of your children back to see your family doctor. It is a good idea to make a video-recording of your sonʼs cough spasms at home to show your doctor because they may not cough as much in the doctorʼs office. This piece of information can help her to make the correct diagnosis.