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Asthma Complexities

Medical Author: Dennis Lee, MD
Medical Editors: Jay Marks, MD, and William C. Shiel, 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.

Doctor to Patient

Asthma Rates Increasing...Are Environmental Exposures?

Medical Author: William C. Shiel Jr., MD, FACP, FACR

Is our environment to blame for increasing asthma rates? 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!

Doctor to Patient

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; inability to exercise properly
  • difficulty sleeping
  • anxiety; difficulty concentrating
  • chronic cough without wheezing

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, 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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Last Editorial Review: 3/21/2005





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