Asthma Symptom You Should Know
Did you know that as many as one in three adults who currently have an asthma diagnosis may be misdiagnosed?
You read that right, folks!
A recent Canadian study, performed on 613 adults who had been diagnosed with asthma within the past five years, did pulmonary function tests. The participants who took asthma medications were weaned off their medications over the course of four clinic visits to see how they performed without medications.
After four visits, 203 people were found not to have asthma, meaning that a prior clinician had misdiagnosed them.
So, why were they diagnosed with asthma in the first place?
One of the researchers, Dr. Shawn Aaron, of the University of Ottawa and the Ottawa Hospital Research Institute, notes that asthma can be very difficult to diagnose because while there is a specific set of symptoms, not every patient has every sign. Also, several conditions can mimic asthma, and that have similar treatment plans.
We will first discuss conditions that mimic asthma, and then we’ll explain asthma symptoms in great detail.
Other Conditions that Mimic Asthma
It is important to have an understanding of what types of conditions may mimic asthma. Why? Because even clinicians, with years of medical training, can make a mistake when it comes to proper diagnosis.
These conditions all have a symptom (or several) that mimics asthma:
- Sinusitis – an inflammation of the sinuses, you may also hear this called a “sinus infection.” It is not uncommon, however, for sinusitis to occur in conjunction with asthma.
- Myocardial ischemia – inadequate blood flow to the heart, and an emergency situation. The symptom that mimics asthma is typically shortness of breath, but likely you’d also be having chest pain, which would hopefully alert your physician (and you!) to emergency treatment.
- Upper airflow obstruction – when the upper airways are obstructed, such as by a tumor or an enlarged thyroid gland.
- Respiratory syncytial virus (RSV) – a virus that causes wheezing and pneumonia in young children and babies, which actually can lead to asthma later in life.
- Bronchiectasis – a lung disease that is caused by repeated infections of the lung, and causes injury to the walls of the airways of the lungs.
What Are the Symptoms of Asthma?
The symptoms of asthma occur because there is an inflammation that occurs in the bronchial tubes. This inflammation causes an increased production of mucus, which subsequently sets off a cascade of symptoms.
We’ve all had a cough before. However, when a cough lingers, it points to something a bit more chronic – such as asthma. A cough that is considered chronic is when the cough lasts longer than eight weeks and can be a telltale symptom of asthma.
Coughs serve a purpose; a cough is meant to remove foreign objects and bacteria that make us ill. There are also two types of coughs – productive and nonproductive. A productive cough is when mucus, also known as phlegm, is expelled. A cough is considered nonproductive when no phlegm is expelled.
An asthmatic cough may also serve a purpose – when phlegm is produced as a result of asthma, the body needs to remove this phlegm, so the cough develops. Sometimes the cough is nonproductive, and this occurs because of swelling and inflammation in the airways.
There is also a variant of asthma called cough-variant asthma, where the hallmark symptom is a nonproductive cough. Those with cough-variant asthma typically have no other classic symptoms of asthma aside from a cough.
It’s also easy to blame a cough on something else, such as a cold or allergies. It is important to look at the context of the cough. What triggers the cough? Examples of common asthma cough triggers may include:
- Outdoor allergens, such as pollens from grass, weeds, and trees
- Indoor allergens, such as mold, dust mites, and pet dander
- The environment, such as humidity, cold air, and rapidly changing weather
- Smoke, air pollution, and strong odors
- Colds, flu viruses, and other illnesses
- Certain medications and food additives
Wheezing is one of the most common symptoms associated with asthma. The wheeze can often be heard even without a doctor or nurse placing a stethoscope to your chest or back.
A wheeze occurs when air moves through the airways that have narrowed due to inflammation and mucus buildup. This narrowing creates a high-pitched “whistle” as you breathe, and it may become increasingly difficult for air to flow through the lungs. The wheeze may be heard on either the inhale or exhale.
Next page: More common symptoms of asthma.
Although wheezing is one of the most common symptoms of asthma, other conditions can cause wheezing as well. As such, wheezing should always be evaluated by a physician. Other conditions that may cause wheezing include:
- Chronic obstructive pulmonary disease (COPD)
- Gastroesophageal reflux disease (GERD)
- Heart failure
- Sleep apnea
- Certain medications
- Respiratory tract infections
- Vocal cord dysfunction
Shortness of Breath
Mild shortness of breath, coupled with the other listed symptoms, can help to diagnose asthma.
It is important to note that when shortness of breath becomes severe, an asthma attack may be occurring. You should have an emergency plan in place for asthma attacks.
Many conditions can cause shortness of breath, mimicking asthma. Examples include allergies, GERD, sinus diseases, and conditions of the heart.
According to the Cleveland Clinic, shortness of breath that is associated with asthma can also be caused by paradoxical vocal fold motion disorder. This causes, “spasms in your throat muscles that make it difficult to get a breath in.”
Chest tightness is a common symptom of asthma. It may occur alone, or it can occur with the symptoms mentioned above.
There are a couple of reasons that can cause the chest tightness that is experienced with asthma. The most common reasons to experience chest pain is simply because frequent coughing can lead to chest discomfort. The inflammation experienced in the airways can also be uncomfortable.
However, asthma can occasionally lead to situations that may cause chest pain:
- Pneumomediastinum occurs when air is trapped in the mediastinum (the space between the lungs and the other organs in the chest cavity). When a pneumomediastinum occurs, pressure increases in the chest cavity, and pain occurs. This condition is uncomfortable but typically resolves itself.
- Pneumothorax may indicate an emergency. A pneumothorax occurs when the lung collapses spontaneously, leaking air between the lungs and the chest wall. A spontaneous pneumothorax occurs in young, healthy people who have asthma. A chest tube may have to be inserted to treat pneumothorax.
Asthma attack Symptoms
An asthma attack can progress quickly and is an emergency situation. Without proper emergency treatment, you can die. Educate yourself on the symptoms and warning signs, and those close to you so that they understand the severity of this situation.
Tachypnea is when breathing becomes very rapid. Shortness of breath may be experienced daily, but when it becomes rapid and challenging to breathe, an asthma attack is likely occurring.
Tachypnea occurs during an asthma attack because something has triggered the lungs to become so swollen, so inflamed that it is tough to move air in and out. Also, bronchospasm is likely occurring. Bronchospasm is when the muscles around the airways begin to tighten. The combination of all of these factors causes rapid breathing, as well as the other symptoms associated with an asthma attack.
Tightened Neck and Chest Muscles
Constricted neck and chest muscles, also called intercostal retractions, occur during an asthma attack. According to Nicklaus Children’s Hospital, “Intercostal retractions are due to reduced air pressure inside your chest.”
The intercostal muscles are the muscles that are between the ribs. When we breathe, these muscles naturally tighten and loosen. However, when the muscles become too tight, an emergency is occurring.
It is important to note that several other conditions may cause intercostal retractions:
- Airway obstruction
Difficulty speaking occurs during an asthma attack as the symptoms above worsen. When tachypnea and intercostal retractions occur, and worsen, it can become increasingly difficult to speak because you are focusing so hard to breathe.
Next page: More symptoms of an asthma attack, and information on how to treat asthma symptoms.
Feelings of Anxiety or Panic
It should come as no shock that when you are unable to breathe or speak, you may become anxious. You may panic. In turn, this will heighten your asthma symptoms because you may begin to breathe even more rapidly, which can cause a panic attack.
But did you know that stress may trigger asthma? According to WebMD, stress is a common trigger. Stress likely won’t cause a new case of asthma, but for those who already have asthma, it may induce asthma attacks, so it is termed “stress-induced asthma attacks.”
Peter Gergen, MD, MPH, a senior medical officer at the National Institute of Allergy and Infectious Diseases, states, “During periods of stress and anxiety, asthma attacks occur more frequently, and asthma control is more difficult.”
According to WebMD, stress wreaks havoc on asthma because “stress and anxiety can cause physiological changes that may provoke an attack. These strong emotions trigger the release of chemicals, such as histamine and leukotrienes, which can trigger the narrowing of your airway.” Also, during stressful times, you may forget to take your medications.
Cyanosis, or a blue tinge to the skin, lips, and nailbeds, indicates that the body is not receiving enough oxygen. This is a symptom of asthma that is extremely uncontrolled, such as during an asthma attack. This symptom would not be present with mild or moderate asthma, except during an asthma attack.
If you note that you may be cyanotic, you should consult your physician or seek emergency medical assistance.
Other conditions may cause cyanosis:
- Heart disease
- Whooping cough
How to Treat Asthma Symptoms
Asthma can be treated daily to prevent symptoms from occurring. Typically, asthma is treated with inhalers, but occasionally oral medications are used as well.
Long-term medications prevent and control symptoms from occurring in the first place. These medications are taken daily. These medications may include:
- Inhaled corticosteroids, which reduce and prevent swelling of the airways. They also decrease mucus production in the lungs. Generally, these types of inhalers are the most effective type of inhalers.
- Inhaled long-acting beta-agonists, which work by relaxing the smooth muscles of the airways. These inhalers should be used in conjunction with inhaled corticosteroids.
- Combination inhaled medicines combined inhaled corticosteroids and inhaled long-acting beta-agonists. These are effective when you require both types of medications.
- Biologics are injections or infusions given every few weeks. They work by targeting cells or proteins in the body and prevent inflammation. Unfortunately, they are costly, so they are used when other therapies have failed.
- Leukotriene modifiers are oral medications that relax the smooth muscles of the lungs and reduce inflammation.
- Cromolyn sodium is an inhaler that does not contain steroids. It prevents swelling when you come into contact with asthma triggers.
- Theophylline is an oral medication that relaxes the smooth muscles.
- Oral corticosteroids are prescribed as a short-term therapy during exacerbations. It also may be prescribed as a long-term therapy when other treatments have failed. They have more side effects than other medications.
Quick-relief medications are used in conjunction with long-term medications and treat symptoms immediately when they occur. They work quickly by relaxing the muscles of the airways. These may include:
- Short-acting beta agonists relax the smooth muscles of the airways. They are the first choice to treat acute asthma symptoms.
- Anticholinergics work slower than short-acting beta agonists. They relax the smooth muscles of the airways and reduce mucus production.
- Combination quick-relief medications contain short-acting beta-agonists and anticholinergics. They may be nebulized or inhaled.
Asthma Action Plan
Everyone with asthma should have an asthma action plan. According to the American Lung Association, an asthma action plan is “a written, individualized worksheet that shows you the steps to take to keep your asthma from getting worse. It also provides guidance on when to call your healthcare provider or when to go to the emergency room.”
An asthma action plan should include the following information:
- Asthma triggers that are specific to you.
- A medication list that includes the specific medications and dosages of your inhalers.
- Your specific symptoms that indicate your asthma is worsening.
- What medications to use based on your symptoms.
- When to seek emergency medication attention, based on your symptoms.
- The following telephone numbers: emergency contact, healthcare provider, and emergency department.
The asthma action plan should be divided into the following zones:
- Green: this is where you want to be daily. There are no symptoms present, and long-term medications are used.