Treatment

Introduction to whoopingcough.net from Dr Doug Jenkinson

Symptoms (sounds and video)

Treatment

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How do you catch it

Laboratory diagnosis

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Prevention/immunization

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Updated July 2016

For the average case of whooping cough there is no treatment likely to make a difference to the course of the illness or materially reduce the symptoms. It will generally take its course no matter what. Attempts to get benefit from bronchodilators, cough suppressants or antibiotics are generally futile.

There are a few exceptions however.

One exception is in those who get severe illness. This is most often infants, particularly those under 3 to 6 months, but it also applies to the frail or very elderly and those debilitated by other illness or malnutrition. In such cases treatment with steroids can reduce the severity and antibiotics might be used to prevent complicating infections. Supportive measures with hydration and oxygenation may be necessary. Such cases would obviously be in hospital. It should be noted that in the developed world one would not expect even 1% of cases (with the exception of infants) to require hospitalization because most cases are mild.

Another exception is when serious complications occur. This is also rare and probably affects about 1 or 2% of cases in the developed world. The most frequent complication is pneumonia which requires standard antibiotic treatment. Some patients get a secondary infection of bacterial tracheo-bronchitis causing increased cough and sputum which may improve with antibiotics, but does not generally cause illness.

For very young babies whooping cough is a dangerous illness and they can die from pneumonia, respiratory failure and encephalopathy. It is to protect babies that we have an immunization program, and it is effective. Many people with whooping cough are given an antibiotic such as azithromycin. This is to kill any Bordetella pertussis they may still carry so as to make it more difficult to pass it on to others. It does not help the disease because the bugs have already done the damage by the time it is usually diagnosed. If however you have such an antibiotic while you are incubating the disease it is believed it may prevent it developing.

The best authoritative advice for professionals on the management of pertussis.
The UK authoritative body, the Institute for Health and Clinical Care Excellence (NICE), has published a Clinical Knowledge Summary on whooping cough. This organisation reflects the best evidence based management for doctors in the United Kingdom of Great Britain and Northern Ireland (Pop. approx. 60 million). I regard this document as the gold standard for management of pertussis. Most of the advice can be applied effectively in most developed countries, most of which do not have such a respected overriding authority.

Role of antibiotics in whooping cough


Management

When there is no effective treatment what remains to be done is management. For babies and children this will be mainly comforting during an attack and reassurance that it will soon pass and they will be fine. Back patting is not going to help but holding and stroking might. If vomiting occurs it is good to be leaning forward or face down if reclining so vomit falls away from the lungs.

Babies who vomit may need refeeding and so might older children. It is common for children to lose weight with whooping cough and is more serious for babies.

Babies should not be left alone when they have whooping cough, even at night, so that problems do not go undetected. This also applies to older children until they can indicate they don't want that, by which point they should be out of any danger.

It should be standard practice for sufferers to be checked by a doctor at least once. Even if it is not diagnosed, a cough that bad need a doctor's examination. A competent doctor will arrange for some investigation of blood, or nasal, or oral fluid if the doctor suspects whooping cough. It is a notifiable disease and effort should be made by the doctor to confirm it. You cannot expect a doctor to test for it if it is not suspected to be the cause. Which test is done will depend on the service available to the doctor.

Note again my advice to capture a paroxysm on your smartphone to assist your doctor with diagnosis.

Sufferers should be removed from the presence of other people when they have an attack of coughing or they should remove themselves. Adults generally do that anyway. This is to reduce transmission. Going outside is even better.

Any general deterioration, particularly if it includes fever or breathlessness needs a medical check for complications such as pneumonia.

Women may well find they leak urine during an attack. This can only be managed by using pads but will clear up when the whooping cough has cleared.

It is vital to keep away from pregnant women in the last half of pregnancy and from children until they have had their primary shots, usually finished at about 4 months, unless you have been told you are no longer infectious.


Tips from patients

September 2006
Christabel's Method
A physiotherapist has emailed me an anecdote that I am inserting below. I have had lots of feedback that this is very helpful for many people. "We have named the following technique Christabel's method after my daughter (9) as she noted that by attempting to stop herself from inspiring reflexively between coughs she could reduce the length and the violence of the cough and prevent reflux. Simply put she delays herself breathing in and holds what breath she has left for as long as possible then tries to breath slowly. This technique may not work on the first cough of the series but in our experience appears to slow down subsequent coughs. The techniques requires practice but does allow the patient some control back in their bodies! As this method requires the patient to overcome their natural reactions I suspect this is only suitable for older children and adults."

Christabel's Method has proved very useful according to my feedback. DJ.

November 2011
Many sufferers of whooping cough find that eating or drinking certain things provokes a coughing spasm. I have been passed anecdotal information from A.H., a paediatric speech and language therapist in the UK who has suggested that some coughing spasms may be due to liquid nourishment leaking past the vocal cords into the windpipe. The theory being that whooping cough might be causing some weakness of the vocal cords (it certainly can cause voice changes). I understand that she has found that thickening liquids before drinking can help this problem. Liquids should be thickened to the consistency of syrup before drinking, using a proprietory thickening agent that can usually be obtained from a pharmacy. One such product that should be easily available is 'ThickenUp® Clear', made by Nestle.
If you suspect liquids are provoking some coughing, this is probably worth a try.
September 2015
I have had a little feedback on this which has not supported its usefulness.