Need to understand Coughing Asthma

[Diane-K]

I've recently read about coughing asthma from other sites.  I learned that not all asthmatics wheeze and that some cough, which is my problem.  However, I would like a better understanding of coughing asthma and whether it fits my profile.  Also, is it a term that all doctors understand or is it fairly new? I read that those who suffer it, don't always seem like typical asthmatics.

Following a cold, flu or even during heavy periods of mold (damp/high humidity), I get a cough so violent that I cannot work.  Episodes last up to 3 minutes, usually ending with a mouthful of frothy, white sputum.  They leave me exhausted and are so intense I sometimes vomit.  X-rays are always negative and my last oxygen level test showed 98%.  I read that all of these are consistent with coughing asthma.  I have not had a spirometry test recently, but I usually do somewhat poorly on these during such periods.

I learned that mold counts have been high with temps above freezing.  I am on 10 mg Zyrtec (good for mold allergies), xopenex (nebulizer), azmacort, Humibid. There has been slight improvement, but I know from experience it usually takes a steroid dosepak to finally nip it.  

What else do we know about coughing asthma and treatment. I do know that dosepaks that start with 6 pills and work down are good for the first 3 days, then it starts to come back as the dose goes down.  I've had better luck when on a steroid for a longer time period.  Thanks

[National Jewish]

The first step is to have your doctor determine that this truly is coughing asthma and not some other breathing problem.  Asthma symptoms can develop at any point in time even in someone who has never had lung problems before.  For some people, the first time they develop asthma is after an infection of their lungs.  This can happen at any age, but is more common in adults.  To know for sure if your symptoms are due to asthma you will need to have testing done.  Generally testing for asthma starts with a simple breathing test called spirometry.  This test provides detailed information about how your lungs are working.  It will show if there is obstruction in your airways.  To really test for asthma this test may be repeated after using a rescue inhaler, a fast-acting inhaled bronchodilator medicine.  This measures how much the bronchodilator helps your lungs by reversing the problem.  When there is a 20% increase the test is positive for asthma.  However it is possible for this test to be normal when a person with asthma is not having breathing difficulty.  A chest x-ray is done to be sure that there isn’t any other problem that would need to be treated differently.  An allergist or a pulmonologist would be the type of specialist to arrange for this testing and to help you get the best treatment. (1265A, 1349A, 1777, add 1793)

With asthma the basic problem is chronic inflammation along with tightening of the smooth muscles that surround the airways of the lungs.  This inflammation is decreased and prevented when an inhaled steroid, like Azmacort® Inhalation Aerosol (triamcinolone acetonide), is used daily.  Bronchospasm is the tightening of the smooth muscles that surround the airways of the lungs.  A fast-acting inhaled bronchodilator medicine, like Xopenex® Inhalation Solution (levalbuterol) by nebulizer, reverses the bronchospasm quickly by relaxing the smooth muscles.  It is most important that the inflammation and your asthma be under good control.  If you need to use a fast-acting inhaled bronchodilator medicine more than twice in a week this means that the inflammation and your asthma are not controlled.  When a long-lasting inhaled bronchodilator medicine is used every day it prevents bronchospasm.  This would have the added benefit of decreasing the need for the fast-acting inhaled bronchodilator medicine.  Doing somewhat poorly on a spirometry test would also show that your asthma is not controlled.  Your doctor may recommend taking a stronger inhaled steroid.  There is much less risk of side effects from an inhaled steroid, so this is a good option instead of taking a steroid dose pack.  In the long run oral steroids are harder on your body than inhaled steroids.  Asthma that is not controlled is harder on your body than using a higher dose of an inhaled steroid.  Please read our Corticosteroid MedFact at http://asthma.nationaljewish.org/treatments/longterm/inhaled_oral.php for more information about inhaled and oral steroids.

When this inflammation is not controlled, it increases the sensitivity of the airways to a variety of things that make asthma worse.  These asthma triggers vary from person to person.  For some people allergies cause more asthma symptoms, but for other people allergies do not cause asthma symptoms at all.  Humidity or an infection, like a cold or flu, are common triggers.  Asthma symptoms also vary from person to person.  The symptoms of asthma are chest tightness, coughing, shortness of breath, and wheezing.  Wheezing is the most common symptom.  So when a person with asthma doesn’t wheeze, they do not seem like typical asthmatics.  However some people only cough.  Coughing can mean that your asthma is not controlled, especially when it is as bad as you have described.  Sometimes this is referred to as cough variant asthma or coughing asthma.  Each person with asthma could have only one of these symptoms or a combination of any of these symptoms, including all four of them.  Please read the information on the National Jewish Medical and Research Center’s website at http://asthma.nationaljewish.org/ for more information about asthma.

It is not clear from the information that you provided if the mouthful of frothy, white sputum is coming from congestion that is above or below your throat.  If the congestion is in your chest this could be due to your asthma.  In some people with asthma, the mucus glands in the airways make a lot of thick mucus that causes chest congestion.  Xopenex® Inhalation Solution (levalbuterol) relaxes the smooth muscle tightness around the airways quickly, but does not do anything for the inflammation and may not work on the mucus.  Inhaled steroids, like Azmacort® Inhalation Aerosol (triamcinolone acetonide), and leukotriene modifiers decrease inflammation and mucus.  When used routinely inhaled steroids have the added benefit of preventing inflammation.

Another source of your sputum could be postnasal drip.  This is drainage from the nose and sinuses dripping down the back of the throat.  You may be swallowing a lot of this mucus into your stomach.  Then whenever you cough you vomit mucus from your stomach.  Talk with your doctor to know if this is a problem for you.  A nasal wash helps remove mucus from your nose and sinuses.  It is most helpful when done daily before using any nasal spray.  A prescription nasal steroid spray decreases mucus production by decreasing the inflammation of the nose and sinuses.  This may prevent the postnasal drip.  A nasal steroid spray does not provide immediate relief of symptoms.  It may need to be used every day for several weeks to months for it to help.  Please read our Nasal Wash MedFact at http://www.nationaljewish.org/medfacts/nasal.html for more information about this technique.  Share this information with your doctor to see if you would benefit from this daily treatment.

[FemaleAge52]

I too am interested in Coughing Asthma.  I have had a cough as mentioned above for 25 years, a non-smoker, coughing heavily several times daily.  7 Years ago Asthma was diagnosed (upper respiratory) but inhalers and steroids never did very much.  I use Buteyko breathing methods and the asthma itself is fine, un-medicated,  but the cough remains.

I am also doing my own research into how I breath and the effect it has on my health and blood pressure.  I have been hypertensive for 25 years also, medicated, and for the last 7 years have had Chronic Fatigue Syndrome.

I noticed that my health improved when I started the Buteyko breathing but I often still breath very shallowly and sometimes catch myself breath-holding.  I notice that my BP is high on waking but I can improve it easily by breathing properly for a few seconds.  It appears to be improving in general as I focus on breathing.  When I am concentrating on something my breathing slows/stops and my BP goes up.

I am wondering about mild sleep apnea (I snore almost all the time and used to have waking episodes where I couldn’t catch my breath – I put this down to asthma and certainly they stopped when I started the breathing exercises).

May I have your advice on how much you think my breathing pattern could contribute to ill-health and how best to change my breathing pattern, in particular at night.

[jkg]

Hello
I have bronchitis like symptoms, but have had this several times over the past 3 years.  Each time it follows a cold or flu and lasts for 4mo to over a year.  It is a deep cough and pain in the upper chest mostly the left side, with some mucous but not always.  As the cold or flu goes away and the cough stays the mucous lessens.  I have been to the Dr. and the lung specialist and they both state that it could be asthma, but I have no other symptoms.  Both will not state that it is asthma for sure.  None of the medications have helped or the xrays or breathing tests both in the Dr. office and in the hospital tests show anything abnormal.  I have spasmotic coughing attacks for appx. 1-3 minutes at a time and am exausted after.  At one point I had to quit my job and could not work for almost 9 months.  I could not go for more than 2 hrs without having to lie down and rest and have very shallow breathing and sometimes hold my breath as not to cough.  These symptoms seem similar to the ones described under this Coughing Asthma.  What to do?  I am so worn out.  Any more info would be appreciated.  I have never heard of coughing asthma until the last year.  I can not take the inhalers and have not found any other treatment.  Have not tried steroids and would rather not, but will try almost anything.  
jkg

[nikl]

To femaleage52. I was excited when I read that you use the buteyko method. I went online one day for my 14 yr son for his asthma and saw this claiming that it really cleared up asthma. I ordered it for 35.00 and it basically was just links to go online to order video's and books on this method. I have not purchased and video's or actual books on the teaching but would really be interested on your input of this method and if it really works instead of investing more money and it not doing anything. Thanks

[FemaleAge52]

I went on the course.  To be honest I was very sceptical but I'd seen it on the QED program on TV a couple of months earlier and the results were remarkable.

The one I went on offered a money back guarantee.

There were 10 of us and everyone reduced or stopped their medications by the end of the weekend.  I'm lazy and I stopped doing my breathing exercises fairly quickly after my breathing got better but you can go back for a refresher and they give you all the support you need.  Eventually my breathing pattern changed and I rarely have to do the exercises now.

There is a little check you can do each morning, a breath holding count, and if your count is down you simply do the breathing exercises.

The only thing I've never been able to get rid of is the cough and to be honest I'm begining to wonder if it may be to do with acid reflux rather than asthma.

Hope this helps, Gay

[Carlak]

In Sept 2003 my daughter (age 12) started coughing at night while she was laying down. No temp. No problems other than cough - only at night. This went on for a few weeks before we went to see our PCP. I'm embarrassed to admit that my PCP always diagnosis as viral "and let it run it's course". So I waited. After a CXR, she was diagnosed with bilateral pneumonia. It took (2) z-paks for it to clear up. This only lasted for a few weeks before the coughing started again. Again, another round of antibiotics and narcotic cough syrup. After months of this, I began to think this was allergies (she had since she was 4)and we saw an allergist. He did testing and put her on Zyrtec and Nasonex. Gradually, her coughing and SOB worsened. Her allergist eventually diagnosed her with "exercise induced asthma" and put her on Advair and albuterol. These inhalers did nothing. Still, a persistant cough but now, she can't even go up a flight of stairs at school without being SOB. Her condition has become completely debilitating to her. She can no longer play basketball because she can't run up and down the court for more than (2) times without gasping for air. Albuterol does nothing. Advair does nothing. Singular was recently added and also, does nothing. Two weeks ago I took her to see an ENT specialist thinking that this might help. He told me that he doesn't think this is bacterial and also does not think this is asthma (by the way, 3 PFT's are not only normal but great). He referred us to Children's Hospital in Pittsburgh to the Pulmonologists. We saw Dr. Finder last week and he was wonderful. Next Monday, we are having an exercise stress test to being looking into other areas of concern (cardiac). What my question is, has anyone heard of similar situations and what was done for the treatment? I have heard about this "coughing asthma" but don't really understand it and would like information on this breathing called "Buteyko". I am worried sick that she may never have the lung compacity that she used to have and may not be able to enjoy the things in life that her peers do. Any advise or comments would be greatly appreciated!!

Thanks!

[sandra151167]

A related discussion, asthma was started.