Sudden shortness-of-breath, wheezing, reaching for an emergency inhaler!… Is this the picture you have of asthma? This asthma stereotype is one possible presentation of asthma. However, many individuals with asthma can have mild, insidious symptoms that escape accurate diagnosis. Diagnosis can also be cofounded by late presentation of symptoms. Although asthma often appears in early childhood, some individuals will not show symptoms until adulthood.
The stereotypical wheeze is just the beginning of possible symptoms for asthma. Other symptoms include:
-More difficulty breathing when outside in cold weather
-Wheeze when laughing
-Increased difficulty taking a deep breath
-Chest tightness with exposure to allergic or irritant triggers
-Cough with exercise
-Slow recovery of normal breathing rate after exercise
-Chest tightness with exertion, such as stairs
-Early morning cough, wheeze, or chest tightness
Symptoms in young children may include, but are not limited to:
-Choosing to quit playing a sport, or giving up physical, recreational activities with their friends
-Waking at night with cough or tightness
-Frequent treatment for respiratory illness
So, how does one know if any of these symptoms are asthma? After all, symptoms that are present in asthma can also be present in other medical problems. Thus, the correct diagnosis may not be immediately apparent.
The best way to pinpoint an accurate diagnosis of asthma is through assessment by an allergist. An allergist is a physician with expertise in the area of asthma, allergy, and immunology. A visit to an allergist for respiratory symptoms will include a review of the medical history and symptoms, lung function testing, possible allergy testing, and x-ray imaging if appropriate. The allergist will also consider other possible causes for respiratory symptoms.
Medical problems that cause asthma-like symptoms include:
-Sinusitis (can cause chronic cough)
-Chronic Obstructive Pulmonary Disease (COPD)
-Heart Conditions (may cause cough or shortness-of-breath)
-Gastroesophageal Reflux (GERD) (often causes cough)
-Vocal Cord Dysfunction (a spasm of the vocal cords that causes wheeze and difficulty breathing)
-Blood Clot in the Lung
-Aspiration or Inhalation of Foreign Body
So what really is asthma? Asthma is a condition in which the airways become narrowed, usually temporarily. Inflammation of the airway is the hallmark of asthma. Inflammation not only narrows the airway, but causes the airway to be more sensitive to triggers that would not bother other people.
Triggers may be allergic or non-allergic. Allergic triggers include pollen, dust mite, and pet dander. Non-allergic triggers include exercise, cold or dry air, illnesses, smoke, chemical odors, anxiety, and stress. These triggers further cause bronchospasm (tightening of the airways when the muscles around the airways contract).
Medical care has made great strides in the treatment of asthma. There are many treatments available that are both very effective and well-tolerated. Inhaled and oral medications are available which control inflammation, prevent bronchospasm, and treat acute episodes. Effective treatment can preserve lung function over the long term. Therefore, detection of asthma in patients that don’t fit they typical stereotype is a worthwhile endeavor!
Written by Dana Dalbak, PA-C
Dana Dalbak, PA-C
Dana Dalbak, PA-C, is a certified Physician Assistant, graduating with a Master’s Degree from Central Michigan University. After placing in the tenth percentile on the National Physician Assistant Certification Exam, she traveled to Gambia, West Africa to complete the rest of her training. Upon practicing family medicine for five years in an underserved part of Michigan, where she has worked with Dr. Siri in Allergy and Asthma specialty care since 2007. She has been a wonderful part of the MASA family since its establishment in 2013.
View Dana’s full biography here.