Asthma and Chronic Cough
Table of Contents
Asthma and Chronic Cough
Asthma can be a challenging condition to diagnose as many of the tests can be normal at a given time. Additionally, children often don’t have the coordination to undertake many of the breathing tests and therefore asthma is initially diagnosed based on a clinical history.
Asthma should be considered if:
- Typical symptoms of cough, wheeze, chest tightness or breathlessness are described
- Episodes are usually episodic and may be worse at night and/or in the early hours of the morning
- Symptoms may be triggered by exercise, emotion, viral infection, cold air and environmental allergens
- Wheeze should usually be heard at some point when listening to the chest
There are several tests which may be undertaken to diagnose asthma – these include peak flow expiratory readings which are done twice daily at home for a period of time. Spirometry is recommended for most individuals over 5 years and fractional exhaled nitric oxide testing may also now be carried out.
Whilst many families may be told that asthma cannot be diagnosed in a child under the age of 5 years, this is now outdated advice and a diagnosis can be made if there are strong suspicions.
Here is a slightly more segmented description about these two issues.
Asthma
Asthma is a chronic disease that inflames and narrows the airways, leading to wheezing, breathlessness, chest tightness, and coughing. These symptoms often occur at night or early in the morning and may be triggered by allergens, respiratory infections, cold air, exercise, or stress.
Issues with Asthma
- Management Challenges:
Asthma requires a carefully tailored treatment plan involving various medicines like bronchodilators and steroids. Compliance with this plan can be difficult, leading to uncontrolled asthma.
- Environmental Factors:
Pollution, allergens, and occupational irritants can exacerbate asthma, making it difficult to control, especially in urban environments.
- Psychological Impact
Living with asthma can lead to anxiety and depression, particularly if the condition leads to lifestyle limitations.
- Coexistence with Other Respiratory Conditions:
Asthma often coexists with chronic bronchitis, leading to overlapping symptoms, which complicates diagnosis and treatment.
Chronic Cough
Chronic cough is a persistent cough lasting more than eight weeks in adults and can significantly impact daily living. It may result from various underlying causes, including asthma, but also gastro-oesophageal reflux, postnasal drip, chronic bronchitis, and more.
Issues with Chronic Cough
- Diagnostic Challenges:
The multitude of potential underlying causes of chronic cough makes it difficult to diagnose. This often results in a lengthy and frustrating process for patients and healthcare providers.
- Treatment Difficulties:
Similarly, treating chronic cough requires identifying and managing the underlying cause, which may not always be possible or straightforward.
- Quality of Life Impact:
A persistent cough can lead to physical discomfort, disturbed sleep, social embarrassment, and even job-related issues.
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Overlap Between Asthma and Chronic Cough
- Asthma as a Cause of Chronic Cough: Asthma can lead to chronic cough, so the conditions may coexist or be confused with one another. A detailed medical history and specific tests are required to identify the actual underlying issue.
- Impact on Treatment: When asthma and chronic cough coexist, treating one without addressing the other may lead to suboptimal outcomes. A comprehensive approach is required to manage both conditions effectively.
- Cost of Care: The overlapping nature and diagnostic complexity of these conditions often lead to higher medical costs, including more frequent doctor visits, diagnostic tests, and medicines.
- Potential for Misdiagnosis: Asthma may be misdiagnosed as a chronic cough or vice versa. This misdiagnosis can lead to inappropriate treatments that do not address the underlying cause of the symptoms.
Conclusion
The issues surrounding asthma and chronic cough are multifaceted and interrelated.
Proper diagnosis and treatment of these conditions require a comprehensive understanding of the underlying causes and triggers, individualised treatment plans, and careful monitoring.
Addressing environmental factors, psychological impacts, and potential misdiagnosis can further enhance care.
Collaborative care involving primary care physicians, specialists, and patient education plays a vital role in managing these challenging respiratory conditions.
With the appropriate attention, individuals suffering from asthma and chronic cough can achieve better control of their symptoms and lead a more comfortable and fulfilling life.
Diagnosing and Monitoring Respiratory Conditions
Many patients come to see us at Dr Helen Allergy because they are frustrated with the lack of a clear diagnosis for their breathing problems. The commonest causes for breathing difficulties are asthma and/or allergic rhinitis (causing nasal congestion and postnasal drip). Nearly all asthmatics have some sort of environmental trigger and 30-40% of those with environmental allergies, have asthma. It is therefore vital that patients are assessed for both, and that both conditions are well managed.
At Dr Helen Allergy, we use two types of breathing tests to assess and manage asthma. These are spirometry and exhaled nitric oxide testing. For most patients we recommend both are undertaken to give a full assessment.
No special preparations need to be undertaken for lung function testing although it is advised that individuals do not smoke on the day of the test and ideally do not take their blue inhaler or other bronchodilators.
Lung function tests are generally not performed on children under 5 as they will not have the coordination required to undertake these tests. Older children and adults will be guided on the technique required.
Spirometry (Lung Function Test)
Spirometry is a diagnostic test used to assess lung function and measure how well a person can breathe. During a spirometry test, a patient typically takes a deep breath and then exhales forcefully into a device called a spirometer, which records various parameters related to their breathing. These parameters include:
- Forced Vital Capacity (FVC): This measures the maximum amount of air a person can exhale after taking a deep breath.
- Forced Expiratory Volume in 1 second (FEV1): It determines the amount of air a person can forcefully exhale in the first second after taking a deep breath
- FEV1/FVC Ratio: This ratio is essential for diagnosing and categorising lung conditions. Abnormal values can indicate conditions like obstructive lung diseases, such as asthma or chronic obstructive pulmonary disease (COPD).
Spirometry is a valuable tool for diagnosing and monitoring respiratory conditions, assessing lung function, and evaluating the effectiveness of treatments. It is used to hep us understand a patient’s lung health and to guide treatment decisions.
Spirometry should not be undertaken within 6 weeks of a recent chest infection as this will affect the readings obtained. In fact, it can take up to 3 months for lung function to return to normal so please let Dr Helen and her team know if there has been a recent infection. Spirometry will also not be carried out if there is any concern of a contagious respiratory infection, if someone is coughing up blood, or if there has been any recent collapsed lung, eye surgery or heart attack.
How Accurate are Lung Function Tests?
Unfortunately, the diagnosis of asthma can be extremely challenging, and tests can be normal, despite a condition like asthma still existing. When taken together with the clinical history, lung function tests are extremely useful, and Dr Helen and her team are experts in assessing the situation.
Exhaled Nitric Oxide Testing (FENO)
Exhaled nitric oxide (FeNO) testing is a diagnostic method used to assess inflammation in the airways of the respiratory system, particularly in diseases like asthma. It measures the concentration of nitric oxide (NO) in a person’s exhaled breath. Here’s how the process generally works:
- Patient Preparation: The patient typically needs to avoid certain factors that could affect the results, such as not smoking or using certain medications (like bronchodilators – blue inhalers) before the test.
- Breathing into a Device: The patient is asked to take a deep breath and then exhale slowly and steadily into a specialised device known as a FeNO monitor.
- Measurement: The FeNO monitor analyses the nitric oxide concentration in the exhaled breath and provides a numerical result.
Exhaled nitric oxide is produced by cells lining the airways, and its concentration can increase in response to airway inflammation. Elevated FeNO levels are often associated with allergic asthma and nitric oxide testing can help Dr Helen and her team in the following ways:
- Asthma Diagnosis: FeNO testing can aid in diagnosing asthma and distinguishing it from other respiratory conditions.
- Asthma Management: It can help monitor the level of airway inflammation in asthma patients and assess how well their asthma is controlled. This information can guide treatment decisions.
- Treatment Adjustment: FeNO results can help Dr Helen and her team adjust medication regimens for asthma patients, potentially reducing the need for steroids when inflammation is well controlled.
- Assessing Treatment Response: Monitoring FeNO levels over time can indicate how a patient is responding to asthma medications or other treatments.
It’s important to note that while FeNO testing can be a valuable tool, it is not the sole diagnostic method for asthma, and results should be interpreted in conjunction with other clinical information. Dr Helen and her team will use a combination of FeNO testing, lung function tests like spirometry, and a thorough medical history to assess and manage respiratory conditions, particularly asthma.
For any allergy questions or issues that you may have, contact us as soon as you can so you can get the correct diagnosis and treatment
