I agree that it's time to call the clinic and have her seen. I am wondering why they have a 13 month old using an inhaler? To me they are not old enough to understand the concept of taking a deep breath in, one reason for using a mask on infants and toddlers for neb. treatments. I would question that and ask for albuterol by neb. instead. Yes, it's more times consuming but time is not really an issue when they are little. Reserve that hassle for when they're teens<img src="i/expressions/face-icon-small-shocked.gif" border="0"> Get her in to the clinic though, it's scary to have her coughing up like that and sometimes not discovering it until morning.