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There are multiple categories of asthma based on cause (see Table 3). A careful evaluation will help define which type of asthma is present in your case. At times, multiple types of asthma are present simultaneously. For example, you may have exercise-induced asthma as well as nocturnal asthma.
TABLE 3
If you have allergic or extrinsic-type asthma, it is likely you have a history of sneezing, itchy eyes and itchy nose as well as asthmatic symptoms following exposure to allergens.
You may suffer allergy symptoms during a particular season due to pollen exposure, or you may suffer symptoms year-round that are worse during the winter, especially when indoors. You also may suffer from exposure to a perennial allergen such as house dust, house dust mite, animal dander (from a dog, cat, etc.) and/or mold.
The Asthma Center specialists can best identify allergic sensitivity through a detailed history followed by allergy skin testing. If you are specifically sensitive to one or more allergens, you may benefit from avoidance of the allergens that trigger your symptoms. If an allergic trigger is found in your home (e.g. house dust mite, animal dander), removal of these triggers can result in a decreased need for medications and can permit better clinical control of symptoms. In addition, there are many environmental measures you and your family can implement in your home and work environments to decrease allergen exposure.
Immunotherapy (allergy injections) is another alternative treatment. Allergy injections work by lowering your sensitivity to a specific allergen and may allow you to tolerate outdoor and/or indoor allergen exposure to a greater extent. Furthermore allergy injections may reduce your overall airway hyper-responsiveness, making you less sensitive to nonspecific, asthma-provoking factors such as infections and air pollutants. Immunotherapy also may prevent the onset of asthma in some susceptible individuals, especially children.
If you have non-allergic or intrinsic-type asthma, it is likely you suffer from asthmatic symptoms following an infection that settles in your chest. Since these infections are usually viral, antibiotics do not help since they are ineffective against viruses. Less frequently asthma may be provoked by bacterial infections often associated with sinusitis or bronchitis. Antibiotics are often essential in these situations.
Symptoms also may be provoked by other non-allergic factors such as weather changes, cold air, exercise, indoor pollutants (formaldehyde, household cleansing products and chemicals, cigarette smoke), outdoor pollutants (ozone, sulfur dioxide, nitrogen dioxide, carbon monoxide) and strong odors (perfumes, scented sprays, fresh paint, moth balls). Allergies are not causing your symptoms if you have intrinsic-type asthma. Therefore you typically will have negative allergy skin tests.
If you have mixed-type asthma, you have both allergic and non-allergic factors that provoke your symptoms.You have some symptoms triggered by nonspecific inhalants while typical allergic factors may also play a role in your asthma. For instance, you may have wheezing episodes with each cold and also have similar symptoms during ragweed season. This type of asthma is seen by The Asthma Center specialists most often.
Exercise-induced asthma (sports asthma, exercise-induced bronchospasm) is a unique form of asthma that may accompany other forms of asthma. If you have pure exercise-induced asthma, then you are free of symptoms at rest. However, when you run or physically exert yourself, you usually become short of breath, feel chest tightness, begin coughing and/or start wheezing. Symptoms of coughing and wheezing frequently begin within minutes after exercising. Resting for a period of time may resolve mild symptoms completely. Exercise-induced asthma is thought to result from cooling and drying of the airways (bronchial tubes) due to increased ventilation (movement of air) and evaporation of moisture from the bronchial tubes.You also may exhibit asthmatic symptoms when laughing or crying. If your exercise-induced asthma is well-managed, you can still lead a physically active life, exercise routinely and usually participate in sports. For example, many Olympic athletes have won medals despite having exercise-induced asthma.
Occupational asthma is a special case of asthma triggered by an irritant or allergen found in the workplace. The incidence of occupational asthma in the workplace is estimated to be about 2%.
Cough-variant asthma refers to asthma in which the major symptoms are repetitive bursts of coughing. Shortness of breath and chest tightness also may be experienced, but wheezing usually is not present. Symptoms do not respond to cough suppressant medication. In contrast, symptoms of coughing respond well to some combination of asthma medications. If you have cough-variant asthma, it is likely you have normal or near normal pulmonary function tests, so the best way to make an accurate diagnosis is with a methacholine challenge (a special breathing challenge test). It is important to have an objective support for this diagnosis since there are so many causes of chronic coughing other than asthma.
Although asthma symptoms do occur at night, nocturnal asthma refers to a condition of suffering frequent nighttime asthmatic attacks.
About 3 or 4% of asthmatic individuals have significant asthmatic symptoms following aspirin ingestion. Therefore, most individuals with asthma rarely note a significant flare of asthmatic symptoms following the ingestion of any form of aspirin or nonsteroidal antiinflammatory medication such as ibuprofen (Motrin®/Advil,® etc.) (see Table 4).
TABLE 4
| Drugs to be avoided | Permissible drugs* |
| antipyrine | acetaminophen |
| diflunisal | choline magnesium trisalicylate |
| fenoprofen | choline salicylate |
| ibuprofen | chloroquine |
| indomethacin | narcotics (e.g. codeine, meperidine) |
| ketoprofen | propoxyphene |
| meclofenamate | salicylamide |
| mefenamic acid | salsalate |
| naproxen | |
| piroxicam | |
| sulindac | |
| tartrazine - (FD&C yellow dye no. 5) containing drugs |
|
| tolmetin sodium |
*Rarely cause symptoms in aspirin-sensitive patients.
If you are aspirin-sensitive, it is likely you have very difficult-to-manage asthma in conjunction with chronic sinusitis and nasal polyps. This combination of symptoms is often referred to as Triad Asthma. If it is suspected that your episodes of asthma are provoked by aspirin ingestion, you may require testing to determine whether you are aspirin-sensitive. If you are in fact aspirin-sensitive, you may benefit from a special aspirin desensitization program.
If your asthma is properly treated, you can generally do well and live a normal life. However, some individuals are at a greater risk of dying from their asthma. You may be at a higher risk if you have a history of any of the following:
The majority of individuals with potentially fatal asthma put themselves at risk by not complying with physician directions and follow-up visits, by overusing their inhaler medication and/or by delaying access to specialty care.
If you have chronic obstructive pulmonary disease, it is likely you also have a significant component of reversible airway obstruction due to asthma. Diligently defining and treating the asthmatic component involved with COPD could lead to significant improvement in your symptoms.
If you have heart disease such as coronary artery disease, valvular heart disease and/or congestive heart failure, you may develop congestion in your lungs related to your heart disease. Treatment of "cardiac asthma" includes medications directed at improving heart function and relieving acute lung symptoms. Long term asthma treatment, unlike most cases of asthma, will not be required unless you also suffer from bronchial asthma.
Factitious asthma is a disorder that mimics asthma but is not asthma at all. Symptoms similar to asthma may be present, but the origin of these symptoms is not due to bronchospasm as it is in asthma. Problems often occur in the upper airway, especially at the level of the vocal cords. Rarely a lung tumor or blood vessel pressing on the bronchi can cause wheezing. Specialized tests will identify factitious asthma.
Although asthma is not a psychological illness, anxiety, stress reactions and other psychological problems may lead to flaring of your asthmatic symptoms. In these cases, you may benefit from stress reduction techniques or psychological or psychiatric counseling as well as asthma medications.
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