Can you have asthma without wheezing?

[KarenV]

My son was recently diagnosed with asthma but has no wheezing.  When he was three he developed a pleural effusion after we were told a small pneumonia had resolved.  We were told this was probably due to inflammation caused by the infection.  Now he is seven.  He got a small pneumonia (one or two crackles before coughing) which we thought had been resolved by antibiotics as his fever went away and he felt much better.  His cough did not go away after another 2 weeks, and in fact sounded wetter,  so we went back to the doctor.  She said both lungs were full of mucus and she felt inflammation caused him to be unable to clear this out.  He began nebulizer treatments three times per day but it still has taken another couple of weeks to resolve the cough.  She is now diagnosing him with asthma.  She is recommending that we restart the nebulizer any time he develops a cough as she believes exposure to infections agents is his trigger.  We are also supposed to bring him in within a day of restarting the nebulizer so that he can be monitored more closely.  He never complained of tightness in his chest or difficulty breathing and has had no wheezing (other than a little wheeze during forced expiration).  It sounds like his inflammation is more distal but I thought asthma involved the upper/larger airways.  There is a lot of asthma in my husband's family but they all have more frequent episodes (asthma attacks) with wheezing and a dry cough.  Is two episodes of inflammation after pneumonia in seven years, with no wheezing, asthma?

[starion]

Yes, folks can have asthma without wheezing.  Cough variant asthma is a very common form of asthma, which sounds like what your son is experiencing.  Also, there are many of us who compensate for our asthma very well and do not complain of symptoms--particularly when our condition gradually worsens and we slowly feel worse and worse without realizing it.  Actually, asthma is frequently a disease of the SMALL airways (rather than large airways).  You can read a lot of great info about asthma at www.NationalJewish.org, particularly their MedFacts, Understanding and AsthmaWizard sections.  Having the doctor closely monitoring your son when he has symptoms of asthma sounds like a good idea, particularly since he's already had pneumonia twice in his seven years.  I'm sure the LungLine nurse will have more info to share with you.
Aloha,
Starion