Asthma Complexities (cont.)
Masqueraders of asthma
"All that wheezes is not asthma." Other medical
conditions can mimic asthma and make the correct diagnosis of asthma more difficult.
Cardiac asthma
Cardiac asthma usually occurs in elderly people who have
wheezing and shortness of breath that are due to heart failure. When the heart is too weak to
pump blood effectively, fluid will accumulate in the lungs. Fluid in the lungs
causes shortness of breath and wheezing. A chest
X-ray can be
helpful in diagnosing heart failure by demonstrating an enlarged heart (usually
a sign of heart failure) along with fluid in the tissues of the lung. Treatment
of heart failure involves using diuretics (water pills) to rid the lungs of excess fluid
and medications to help the heart muscle pump more effectively. When the heart
failure has been adequately controlled, the wheezing will cease. Some people may
suffer from asthma and heart failure simultaneously. These patients require
treatment for both conditions.
Other bronchial conditions
Acute bronchitis. Acute
bronchitis is an infection, usually viral or bacterial, of the bronchi, the
larger airways or breathing tubes. The symptoms
of acute bronchitis include fever, cough, yellow or green sputum, and, sometimes,
wheezing. This combination of coughing and wheezing is sometimes referred to as
"asthmatic bronchitis" or post-viral bronchial hyperreactivity
of the airways. Acute bronchitis is generally treated with antibiotics and/or
antiinflammatory medications such as corticosteroids. The coughing and wheezing
usually subside within a few weeks. Some patients with asthma can produce green mucus that may not reflect an ongoing infection but the consequence of airway inflammation or allergic response.
Chronic bronchitis. Chronic
bronchitis usually is defined as a daily cough with production of sputum for
three months for two years in a row. The most common cause of chronic bronchitis
is cigarette smoking. With chronic bronchitis, there is longstanding inflammation
and swelling of the inner lining of the airways, and the inflammation and swelling
cause narrowing of the airways. The inflammation also stimulates production of
mucous within the airways that becomes the sputum produced by coughing.
Infections of the airways with viruses or bacteria are common among individuals with chronic bronchitis. Infections
further aggravate the inflammation and narrowing of the airways, worsening the
symptoms of shortness of breath, coughing, and wheezing. Treatments include
antibiotics, quitting cigarette smoking, bronchodilators to expand the airways,
and corticosteroids to reduce the inflammation.
Emphysema. Emphysema is a disease where there is permanent destruction
of the walls of the air sacs (alveoli) and the small
airways (bronchioles). The destruction of the alveolar walls reduces the elasticity of the lung. Loss of
elasticity leads to the collapse of the bronchioles, obstructing airflow out of
the alveoli. Air becomes permanently "trapped" in the alveoli. Air trapped in
the alveoli cannot be exchanged for room air, and this reduces the ability of
the lung to get rid of carbon dioxide and take in oxygen. Emphysema is most
often caused by years of cigarette smoking; however, a genetic disease, alpha-1
antitrypsin deficiency, also causes emphysema.
The combination of chronic bronchitis and emphysema is
called chronic obstructive
pulmonary disease (COPD). The major symptom of emphysema is shortness of
breath. Patients with emphysema also may wheeze if they also suffer from chronic
bronchitis and/or asthma. Treatment of these latter patients begins with smoking
cessation and the use of inhalers to deliver bronchodilators and corticosteroids
to the lungs. Antibiotics, oxygen, and surgery in the advanced
stages of these diseases also can be helpful.
Bronchiectasis.
Bronchiectasis is a chronic condition in which the bronchial tubes (larger
airways) are damaged by repeated bronchial infections. The major symptom of
bronchiectasis is a persistent cough with thick and usually green mucus. Bronchiectasis is treated with bronchodilators, antibiotics, and
corticosteroids when flare-ups occur.
Cystic fibrosis is an inherited condition in which the affected patients can
produce thick mucus that plugs the bronchial tubes. The plugging of the
bronchial tubes causes repeated bouts of bronchitis and pneumonia, leading to
the development of bronchiectasis.
Localized bronchial
obstruction. Wheezing and coughing can be symptoms
of a localized obstruction of the airways (the bronchial tubes or trachea). The
wheezing represents the sound of air rushing around the blockage, and the
coughing is the body's effort to clear the blockage. The most common causes of
localized airway obstruction are foreign bodies such as accidentally inhaled
peanuts, bronchial tumors, and the narrowing of the trachea that occurs after a
tracheostomy. The
wheezing and coughing due to a localized obstruction will not respond to
medications for asthma. The treatment is to relieve the obstruction.
Next: Vocal cord dysfunction (VCD) »
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