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Respiratory Health · Allergy & Asthma

The Cough That Came Back Every Harmattan
Why Chioma's Annual Chest Tightness Was Never "Just a Cold"

Chioma had been given cough syrups and antibiotics every harmattan for 6 years. Nobody had ever spirometry tested her. Mascot Healthcare confirmed cough-variant asthma and an inhaler stopped her seasonal cough pattern entirely.

Composite patient journey Names changed for privacy Mascot Healthcare, Akoka
📝 Note: This is a composite clinical narrative — constructed from multiple similar presentations at Mascot Healthcare. It accurately reflects the typical diagnostic experience. Patient details have been generalised for privacy.
The Patient
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Chioma Obi, 27

Personal trainer, Gbagada. Presented with 6th consecutive year of a dry, persistent cough lasting 6–8 weeks every harmattan season — with chest tightness and wheeze on exercise. Spirometry showed mild reversible airflow obstruction. Managed empirically as cough each year; never diagnosed.

Allergic Bronchitis / Cough-Variant Asthma
How It Started

Six Years of Cough Syrups for an Airway That Needed an Inhaler

Chioma had given up expecting to be symptom-free in harmattan. Every November, the cough started. She went to the pharmacy, got a combination cough syrup (containing an antihistamine and sometimes an antibiotic), took it for 2 weeks, and waited for February. The cough always went by itself by March.

This year, the cough was affecting her training — she was coughing during sprint sessions and had a noticeable wheeze after HIIT workouts. A client who was a doctor asked if she had ever had a breathing test. She hadn't.

At Mascot Healthcare, spirometry was performed. The pre-bronchodilator result showed mild airflow obstruction. After salbutamol was inhaled, the FEV1/FVC improved dramatically — confirming reversibility. "This is cough-variant asthma," the doctor said. "You've been treating it with cough syrup for 6 years. You need an inhaler."

Symptoms

Six Harmattan Seasons of the Same Cough

Cough-variant asthma presents as a persistent dry cough — often without wheeze or classical dyspnoea — typically triggered by cold air, exercise, or allergens. It is the most common cause of chronic persistent cough in young adults.

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Dry Persistent Cough × 6 Weeks Each Harmattan

A dry, hacking, non-productive cough starting every year in November and lasting until February.

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Chest Tightness on Exercise

A tight chest sensation during runs — worse in cold early-morning training sessions.

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Post-Exercise Wheeze

A mild audible wheeze after high-intensity training sessions — "like my chest is tight after sprints."

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Seasonal Pattern (Harmattan Only)

Completely asymptomatic from March to October — the seasonal pattern points strongly to an allergen trigger.

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Reversible Spirometry Changes

Pre-bronchodilator FEV1/FVC 72%; post-salbutamol: 84% — significant reversibility confirming reactive airway disease.

Before the Clinic

Six Years of Empirical Cough Management

Combination cough syrup (antihistamine + dextromethorphan) — suppressed the cough partially; did not address the airway inflammation.

Antibiotics (3 courses across 6 years) — no bacterial cause; no effect on allergic bronchitis.

Hot lemon and ginger — soothing; no pharmacological effect on bronchospasm.

Wearing a scarf over the mouth in the cold — partially helpful by warming inspired air; not treatment.

⚠️ Why this matters: Cough-variant asthma is an inflammatory airway condition. Cough syrups suppress the cough reflex without addressing the underlying bronchospasm and airway inflammation. Six years of undertreated asthma risks fixed airway remodelling — permanent reduction in airway calibre.
At Mascot Healthcare

Spirometry Confirmation and Inhaled Therapy

Cough-variant asthma confirmed on spirometry (reversible airflow obstruction). Allergen history: house dust mites and cold dry air — the dominant harmattan triggers.

Treatment: a daily preventer inhaler, with a separate reliever inhaler for breakthrough symptoms. Technique was demonstrated and checked. She was told to use the preventer inhaler daily from October through February — the harmattan months.

Exercise-induced symptoms: a dose of the reliever inhaler shortly before training to prevent exercise-triggered bronchospasm. A written asthma action plan was provided.

Diagnosis & Treatment

What Was Found — and What Happened Next

1

Diagnosis

Cough-Variant Asthma / Allergic Bronchitis (spirometry: reversible airflow obstruction; seasonal harmattan pattern; exercise-triggered wheeze)

2

Treatment

Daily preventer inhaler Oct–Feb; reliever inhaler as needed; pre-exercise reliever inhaler; written asthma action plan; allergen control; spirometry repeat in 3 months

3

Follow-up

At 3 weeks on inhaler: cough completely resolved for first time in November. No exercise wheeze. At 3 months: spirometry normalised.

Outcome

First harmattan in 6 years without a cough. No exercise wheeze. Spirometry normalised at 3 months. Chioma continues the seasonal inhaler protocol.

What This Story Teaches Us

What Chioma's Story Teaches Us

A dry persistent cough that recurs annually, worsens in the cold, and is associated with exercise wheeze should be spirometry tested before year 2 — let alone year 6.

Cough-variant asthma responds rapidly and completely to inhaled corticosteroids. The cough syrup was never the right treatment.

Key takeaway

Annual harmattan cough with exercise wheeze is cough-variant asthma. A spirometry test and an inhaler fix it — cough syrups never will.

Recurring cough every harmattan or chest tightness during exercise? Get a spirometry test at Mascot Healthcare.

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