How do I Best Treat My Cough Variant Asthma?
- Thursday, July 16, 2009, 23:32
- Asthma
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- Tonya: I’ve been diagnosed with cough variant asthma. My asthma seems different from what other people I know experience with the disease. I never wheeze, and my peak flows can be high even when my chest feels extremely tight. My reaction to irritants is to cough, so hard that it feels like I’m choking and I just can’t stop. It can be miserable. I’d like to know more about this type of asthma and how to live with it. I have coughed so hard I’ve broken blood vessels, even to the point of vomiting. Do you have any advice?
- Dr. Kraemer: Cough variant asthma has been diagnosed for years. The original descriptions were typical of your case. An individual with cough variant asthma may constantly cough, especially with cold air and irritant odors. They have normal resting lung function, but an increased bronchial hyper-responsiveness or bronchial “twitchiness” on a bronchial provocation test called a methacholine challenge. Once the diagnosis is made, the definitive step is to minimize the cough by using an effective combination of asthma medication. If the diagnosis is correct, this almost always succeeds. If asthma medication doesn’t work, then you need to consider the many other causes of chronic cough. In my own practice, I have been “fooled” by a clear-cut diagnosis of “cough asthma”. Patients who coughed throughout the day and even had abnormal bronchial hyperreactivity on the methacholine challenge, continued their symptoms after starting effective asthma medicines. In a few, we later discovered that the cough was primarily from an ongoing reflux of stomach acid. In others, it was related to an irritating postnasal drip from sinusitis. In others, it had become a habitual behavioral mannerism. One small boy forgot to tell us about the piece of plastic he had aspirated several months before. So, if your “cough asthma” does not respond rapidly to effective medicines, it may be time to return to your doctor.
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