Asthma Complexities (cont.)
Can a cough without wheezing be due to asthma?
Chronic coughing is frequently defined by doctors as a cough that lasts longer than
three weeks. Chronic cough can have
several causes such as postnasal drip,
pneumonia, bronchitis,
cigarette smoking, acid reflux, heart disease, lung cancer, and medications such as ACE inhibitors used
for treating high blood
pressure.
Asthma also can cause chronic cough.
A chronic cough may be the only symptom of asthma. The
cough may first appear after a cold or an upper respiratory tract infection. The cough may also start
as a "tickle" in the throat. In some patients with asthma, laughing or exercise
can bring on coughing. Other patients tend to cough at night while others cough
at any time of day without provocation. It is very important that anyone with an undiagnosed chronic cough receive a chest radiograph to exclude more serious disease.
Coughing due to asthma may not respond to cough
suppressants, antibiotics, or cough drops but only to medications for asthma.
Therefore, accurately diagnosing asthma (by using pulmonary function tests) is
important. Thus, a doctor, preferably a lung specialist or an allergist, should evaluate
any cough that does not resolve on its own within three to six weeks.
Nocturnal asthma
More than 90% of patients with asthma experience nighttime wheezing and
coughing. Symptoms of asthma are most common between midnight and 8 a.m. and are
important causes of insomnia and sleep deprivation among
patients with asthma. In fact, sleep disturbances in patients with asthma
usually mean that there is inadequate control of the asthma and should prompt a visit to the doctor to
re-evaluate the treatment being used for the asthma.
Function of the lungs in a patient with asthma can decline by up to 50%
during an episode of nocturnal asthma. The reasons are not clear, but possible
explanations include:
- exposure to allergens at night such as dust mites or animal dander;
- a decrease in cortisone and adrenaline levels
that normally occurs at night, resulting in increased reactivity of the
airways;
- reflux of stomach acid into the esophagus;
- cooling of the airways that cause spasm of the major
airways;
- sinusitis and postnasal drip; and
- sleep apnea.
It is possible to test for nocturnal asthma by taking measurements of airflow
out of the lungs during expiration in the evening and again upon awakening in
the morning. This is done with a small portable meter that measures the flow of
air. (An asthma specialist can demonstrate the correct technique for making
these measurements.) A greater than 20% decrease in the peak flow measurement
from the evening to the morning suggests nocturnal asthma.
Next: Masqueraders of asthma »
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