EAACI Molecular Allergology User's Guide 2.0 - Dramburg - 2023 - Pediatric Allergy and Immunology
Dear Doctor: How Could My Doctor Verify If I Really Have Cough Variant Asthma?
DEAR DR. ROACH: I also have a dry cough that's been going on for about 13-14 years. I'm a healthy 62-year-old and read that it is called "cough variant asthma." I would like to know more about this but really can't find anything about it, except that it will eventually get worse if it's not treated. I was checked twice in the past 15 years for asthma, and I wasn't diagnosed. However, I've not been diagnosed with any acid reflux or postnasal drip. -- D.S.
ANSWER: Although most people think that asthma causes wheezing, cough is a very common symptom of asthma. You've named the two other most common causes of chronic cough: acid reflux and postnasal drip. It can be tricky to make these diagnoses.
Very often, primary care doctors will do a "therapeutic trial" that involves a short-term prescription to see if there is improvement. For acid reflux, it might be an H2 blocker like famotidine (Pepcid), which acts faster than a proton-pump inhibitor like omeprazole. This is often faster, easier, and much less expensive than a diagnostic test like a 24-hour pH monitor (the gold-standard diagnostic test).
Similarly, a physician might give a trial of asthma medication (such as a bronchodilator like albuterol) to see if it stops the cough, rather than immediately testing a person's pulmonary function with a trial of bronchodilators -- a standard diagnostic test for asthma. Sometimes a pulmonologist will order a "methacholine challenge test" where an airway irritant is given at very low doses to see if it will trigger an asthma response in the lung. Postnasal drip can sometimes be confirmed by a physical exam, but a fiberoptic laryngoscopy is seldom necessary to make the diagnosis.
When the therapeutic trials are not helpful, these diagnostic tests become necessary. I personally order lung testing before and after bronchodilators on all patients with suspected asthma, as the tests give important information beyond a diagnosis. Lung testing can be used to follow the course of the disease and identify whether there may be a separate problem in addition to asthma.
DEAR DR. ROACH: I am a 69-year-old male. I exercise five days per week and eat healthy. I take losartan, simvastatin, Xarelto and metoprolol. I have gotten the COVID and flu shots yearly but still end up catching the flu. What gives? -- J.L.P.
ANSWER: I wish the flu shot was perfect, but it isn't. Each year, the flu shot is usually around 30% to 50% effective at protecting people from getting the flu. Still, 50% protection is a lot better than no protection at all. Furthermore, if you do get the flu, people who have received the vaccine tend to have milder cases, which is very similar to the COVID vaccines.
The flu is pretty contagious, so if you are in close contact with a lot of different people, you are likely to get exposed. You can reduce your risk of the flu (and COVID) by keeping away from large groups or wearing a mask, in addition to getting your yearly vaccine.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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Asthma Cough
A chronic dry cough is a common symptom of asthma. Inhaled corticosteroids, quick-relief inhalers, and oral medications may help ease asthma symptoms, including a cough. Some alternative treatments may be helpful, too.
While many people first think of wheezing or gasping for breath when it comes to asthma symptoms, there's also an association between an ongoing (chronic) cough and asthma.
Learn more about asthmatic cough and how to treat the symptoms of this chronic condition.
Coughing has a purpose. Your body has you cough to remove foreign particles and bacteria to prevent possible infections.
Coughing in people with asthma can be helpful because it's one of the body's natural defense mechanisms.
There are two main types of coughs: productive and nonproductive.
When a cough is productive, it means that a noticeable amount of phlegm is expelled. This enables the lungs to get rid of harmful substances. A productive asthmatic cough will expel phlegm and mucus from the lungs.
But in most cases with asthma, the cough is considered a nonproductive dry cough. It's a response to an irritant that forces the bronchial tubes to spasm or constrict.
Swelling (inflammation) and constriction of the airways — which prompts this type of nonproductive cough — characterizes asthma.
An asthma cough is also often accompanied by wheezing. This is a high-pitched whistling sound caused by a constricted airway.
A cough is a very common asthma symptom. In some people, cough is sometimes the only noticeable symptom of the condition.
When figuring out whether your cough is due to asthma or not, it may be helpful to assess any other related symptoms you have.
Symptoms associated with asthma cough
Other possible asthma symptoms include:
With asthma, a cough can be troublesome, especially at nighttime. It makes getting restful sleep difficult and sometimes requires special treatment.
Night coughs are most often related to gastroesophageal reflux disease (GERD), asthma, and other breathing problems such as emphysema.
Symptoms not associated with asthma cough
It's also important to understand symptoms that are not associated with asthma cough. Seek emergency medical attention if any of the following symptoms accompany your cough:
Before you start any treatments for asthma cough, a doctor will likely do a physical exam. They may also order breathing tests to measure your lung function. You may need to have these tests done periodically to measure the effectiveness of any medications you're taking.
These diagnostic tools are most effective in people ages 5 and older. A doctor might also do allergy testing if they suspect allergens are triggering your asthma cough.
In some cases, a doctor may also prescribe a steroid inhaler and assess your response to the medication to diagnose asthma.
There are several treatment options for asthma and its related cough.
Traditional treatments
Controller medications are a commonly used method of treating asthma. Inhaled corticosteroids help decrease lung inflammation, one of the causes of asthma cough. These are used on a long-term basis, unlike oral corticosteroids, which are used for short periods of time during severe flare-ups.
Doctors prescribe quick-relief inhalers to have on hand in case of wheezing and coughing flare-ups. Most of these treatments fall into the class of short acting beta-antagonists.
According to the American Academy of Allergy, Asthma, and Immunology, quick-relief inhalers should not take the place of controller medications and should be used less than twice a week. A doctor may also recommend them for use before exercise or during an illness.
Consider talking with a doctor if you find you rely on your quick-relief inhaler more often than recommended.
Long-term oral medications such as leukotriene modifiers may also relieve asthma cough. One such drug is montelukast (Singulair). Leukotriene modifiers work by treating asthma symptoms related to allergic rhinitis.
Alternative treatments
Alternative treatments may help an asthmatic cough, but they are complementary treatments. Never use alternative treatments in a medical emergency or stop prescription medications for homeopathic medicine.
Reach out to a doctor if you want to try any of the following options to help with your asthma coughing:
Aside from treatment, you can help decrease how often you experience your asthma cough with a few lifestyle changes. For example, placing a humidifier in your room can help ease coughing at night. You may also have to limit outdoor activities if the air quality is inadequate.
One of the most important prevention tools for living with asthma is learning to identify your asthma triggers.
You should avoid irritants and triggers that can worsen your cough. Some common triggers include:
If allergies make your asthma worse, you may also need to prevent and treat allergen exposure before your asthma symptoms get better.
While asthma itself is not "curable," you can manage your symptoms and find relief. Treating asthma symptoms like coughing is also important to prevent lung damage, especially in children.
With proper management, your cough should eventually ease. Be sure to reach out to a doctor if your asthma cough continues despite treatment.
Your Good Health: A Dry Cough Persisting For A Decade Might Indicate Asthma
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