Asthma Complexities

  • Medical Author:
    George Schiffman, MD, FCCP

    Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick GuideAsthma Symptoms, Causes, and Medications

Asthma Symptoms, Causes, and Medications

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 is usually 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, which 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.

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