Hi, my name is Dr. Chet Tharpe, and I’m a board certified allergy specialist in South Carolina. This video blog is focused on adult onset asthma and this is in response to a post that I saw on the asthma support group on Facebook.
The member posting reported that they had asthma since they were born and only rarely had asthma attacks during childhood triggered by smoke or cold viruses. He stated he went several years without any symptoms at all. However, over the past few weeks, this member stated that they are just not breathing well. Specifically they reported they felt like somebody was sitting on their chest and that they also have a constant, dry cough, with very little mucus. He reported that he is 35, not overweight, and has a very clean house with an air purifier and without carpet or curtains. He was confused as to the cause of his symptoms and also stated he felt frustrated that his doctor wasn’t doing enough to help him determine a cause for his symptoms. He was wondering if his symptoms could be related to his childhood asthma making a comeback and now establishing itself as adult onset asthma.
So if this is you, or you can relate to this scenario, hopefully I can shed a little light on the scenario and the subject of adult onset asthma. Please remember, as I say in all of my posts, I am not your doctor. So please do not interpret anything I say as direct medical advice.
As allergy and asthma specialist, I see asthma patients day in and day out and am truly passionate about asthma treatment. I see a large subset of patients who have adult onset asthma. Typically, these patients have either no history of childhood asthma that they can remember or similar stories to the poster that they had a little bit of asthma as a child. They may have had an inhaler that they used from time to time during various parts of childhood but most don’t seem to remember asthma as being a major limiting factor growing up. But now as an adult in their late 20s, 30s or 40s, asthma has seemed to newly develop or reappear with symptoms including chest tightness, shortness of breath, wheezing or cough that are nothing like the patient can remember ever experiencing before.
Again this is a very common occurrence. Asthma being an inflammatory condition of the lungs, means these patients airways, in response to various triggers are getting more reactive. The airways become tight or constrict, the cells that line the airways swell and produce mucus. Air flow out of the lungs becomes obstructed which restricts airflow into the lungs and symptoms occur such as chest tightness, shortness of breath, wheeze and cough.
So why did this happen? Why does this happen in adulthood? Why does asthma occur at any age? The simple answer is we just don’t know. Again, this is an inflammatory or immune system issue where at this point in the person’s life their immune system has changed and has become much more reactive. These people have essentially grown into asthma. But even though you’ve possibly grown into asthma in adulthood, that doesn’t mean you can’t grow out of it at some point in time.
Thankfully there are really safe and effective asthma medications that can help you through this difficult period. And the medicines that are started don’t have to be forever as there needs to be constant reassessment on the needs of medication in hopes of getting you on the least amount of medication to control your symptoms. There is also the hope and possibility that you can eventually grow back out of asthma or put another way, it can go into remission where you can get off all medications at some point.
So if you were to present to my clinic with this scenario of chest heaviness and constant dry cough in your mid 30s with a distant history of childhood asthma, number one we want to make sure is this asthma. We will discuss when specifically you are experiencing your symptoms keying in on the most problematic times for asthmatics which are late at night and early in the morning along with exertional scenarios. We will likely perform Spirometry before and after albuterol to get objective measures of your lung volume and to identify reversibility which we see as an increase in your lung volume after albuterol which is characteristic of asthma.
Albuterol, the medicine in your rescue inhaler or nebulizer is what we call a short acting, beta agonist that relaxes the lung muscle and within minutes, pops your lungs open. Asthmatic, inflamed lungs typically respond to albuterol and you should feel as though your chest is opened up and you can breath better shortly after use. If you don’t feel as though albuterol helped or we are not able to detect an increase in your lung volume on Spirometry after albuterol use then we need to start thinking about other causes. Other investigations that can be helpful include lung imaging such as a chest Xray and CT scan. We may need to also think of causes outside the lungs including heart or gastrointestinal related causes. Both of which can occur alone and mimic asthma or can occur along with and exacerbate asthma.
There are times however in asthmatics where Spirometry will not tell the entire story. That may be due to the fact that Spirometry, which requires a great deal of effort, is not done appropriately. Or that albuterol is not inhaled correctly and does not get into the lungs where it can relax the lung muscle thereby increasing the lung volume.
Thus, if there is doubt that it may be asthma, while considering other causes, there is generally no harm in giving a trial of an asthma med such as an inhaled steroid alone or along with a long acting beta agonist which is essentially just a long-acting form of albuterol.
So, I believe in the comments the poster reported they were on Breo and said that it was working. Breo is a combination medication that has a long acting beta agonist called vilanterol that lasts 24 hours, along with the fluticasone furoate, which is a long acting steroid. And given the fact that asthma is an inflammatory condition, these medicines should both help.
I will typically give you a few weeks of a trial on these meds and then reassess. If you’re not feeling better in a couple weeks with diligent and appropriate inhaler use ensuring the medication is getting in your lungs, I start to highly question that this may not be asthma.
However, I still suspect asthma but you have not improved due to possible inadequate inhaler technique or some other issue, I may prescribe a course of oral steroids like prednisone and assess your response after 4 or 5 days. Prednisone, as long as you can swallow a pill, should improve the asthma symptoms dramatically and give us a clue as to whether this is truly asthma or not. It is not the long-term solution but can give us a very strong diagnostic clue as to what is going on in your lungs and how we can best manage it.
If this is asthma we can prescribe medicines to control your symptoms. Control means which you’re feeling good and living life normally with very little use of your inhaler, being able to exercise without limitation and not waking up in the middle of the night because of your asthma.
When asthma is controlled it is an afterthought. After about 3-6 months of good control, asthma medications should attempt to be tapered.
In summary, adult onset asthma is common. First, we want to confirm whether this is or isn’t asthma and this can be done using the combined knowledge we get from your symptom history, your lung testing and your response to anti-inflammatory medications. We also want to consider contributing or co-existing factors if any, such as allergic triggers or gastrointestinal reflux.
So, I hope this has helped you in your respective situation and also hope it will stimulate a productive discussion with your physician. If you liked this video, please leave me a comment and subscribe to my e-mail list where I can keep you updated on new videos and educational opportunities through ChetTharpeMD.com. Thanks for your support! Great days are ahead!