Asthma Complexities
Medical Authors: Dennis Lee, MD, and George Schiffman, MD,
FCCP
Medical Editors: Jay Marks, MD, and William C. Shiel Jr., MD, FACP, FACR
What do all of these individuals have in common? An
active 13-year-old becomes breathless shortly after her soccer games and coughs
on a cold winter's night. A young woman has a dry, hacking cough that has
persisted for a year after her last "cold." A teenager sleeps poorly and is
awakened early every morning with chest tightness and difficulty breathing. What these individuals
have in common is the possibility that they all may have asthma.
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Asthma Rates Increasing...Are Environmental
Exposures?
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Scientists and physicians have noticed that the rates of asthma have
been increasing in recent decades. This has been especially true in
developed countries such as the United States. In fact, the American
Lung Association has reported that asthma prevalence has risen from
34 cases/1000 people in the general population in 1982 to 56
cases/1000 in 1994.
Research into the causes of this striking increase in asthma has led
to a number of possible explanations being proposed, but there has yet
to be unanimous agreement on the reasons.
A study reported in the American
Journal of Respiratory and Critical Care Medicine (1999; 159:125-29)
evaluated a group of patients at two points in time, 30 years apart.
The study performed by doctors in Scotland detected a significant
increase in symptoms of allergic asthma and levels of antibodies to
environmental allergic factors, such as dust mites, pets, and air
pollutants over the three decades. Importantly, the researchers
noted that there was an increase in the signs and symptoms of
allergy, even in people without a family history of allergy!
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Unusual symptoms of asthma
Patients suffering from episodes of asthma do not always have the
typical symptoms of asthma such as shortness of breath, chest tightness, and
wheezing (symptoms of airway narrowing). Instead, patients can have symptoms
that may not appear to be related to asthma. These "unusual" asthma symptoms
include
- rapid breathing,
- sighing,
- fatigue and inability to
exercise properly,
- difficulty sleeping,
- anxiety and difficulty
concentrating,
- chronic cough without wheezing,
- protracted cough after an upper respiratory illness,
- recurrent diagnosis of walking pneumonia, and
- noises emanating from the chest usual during exhalation.
To complicate matters, symptoms of asthma are not consistent and often vary
from time to time in an individual. In some patients, symptoms are influenced by
diurnal factors; for example, some patients experience asthma primarily at night
(nocturnal asthma) rather than during the day. Furthermore, episodes of asthma
can be triggered by many different factors such as allergens, dust, smoke,
perfumes, cold
air, exercise, infections, medications, and acid reflux. Finally, other illness
such as heart failure, bronchitis, and dysfunction of the vocal cords can cause
symptoms that mimic those of asthma. For these reasons, accurately diagnosing
and treating asthma can be a challenge.
For a comprehensive review of symptoms, causes, and treatments of asthma, and
for a better understanding of the normal anatomy of the airways (trachea,
bronchi, bronchioles and the lung), please visit the asthma article.
Next: Can a cough without wheezing be due to asthma? »
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Asthma Complexities
Reflux Laryngitis »
Why does reflux laryngitis occur?
Reflux is caused by weakness in the muscle at the junction of the
esophagus with the stomach. Normally, this
muscular valve, or sphincter,
functions to keep food and stomach acid from moving upward from the stomach to
the esophagus and larynx. This valve opens to allow food into the stomach and
closes to keep the stomach's contents from coming back up. The backward movement
of stomach contents (gastric contents) up into the esophagus is referred to as
gastroesophageal reflux.
Additionally, any increase in abdominal pressure (such as obesity),
which can push acid back from the stomach up the esophagus, or a patient with
a hiatal hernia, will have an increased risk for reflux. When it causes
symptoms, it is referred to as gastroesophageal reflux disease (or GERD).
When the acid backs up into the voice box (larynx), the condition is referred to
as reflux laryngitis.
Stomach acid can cause irritati...
Read the Reflux Laryngitis article »
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