The question: I have trouble breathing in cold weather and when I have a cold. My doctor tested me for asthma and the tests were normal, but sometimes when I use my husband's puffers I feel so much better. What do I have?
The answer: Asthma is a common disease of the respiratory system that involves chronic inflammation of the airways. In addition to increased mucous production and swelling, the muscles in the airways become hyper-reactive and narrow when irritated. This reaction occurs when people are exposed to cold air and allergens such as pet dander or dust. It can also stem from an upper respiratory tract infection such as the flu or from exercise.
Shortness of breath, wheezing and coughing are some of the symptoms of asthma.
When treating asthma, it's helpful to avoid triggers and use puffers that decrease inflammation and open the airways to allow oxygen to flow freely in and out of the lungs. Bronchodilators and steroid inhalers are the most commonly used types of puffers that help to relax the muscles. Using the latter for a short period of time may help following an upper respiratory tract infection where a persistent cough may last for weeks despite clearing of the infection.
A relatively newly recognized cause of chronic cough is called non-asthmatic eosinophilic bronchitis (NAEB). Similar to asthma, it involves inflammation of the airways but does not have the same muscle hyper-responsiveness. Even though the above treatments work for NAEB, all diagnostic tests for asthma will be negative.
I suggest that you revisit your symptoms with your doctor and review the tests that have been conducted. If you have a chronic cough, it's important that you consider getting pulmonary function tests, a chest X-ray and a methacholine challenge test to assess how responsive your airways are to irritants.
If these tests come back negative, then your doctor can check for NAEB by testing the sputum (phlegm) to look for the presence of specific markers. Your doctor may also choose to do a trial of therapy with a steroid inhaler to see if your symptoms improve. While it may be convenient to use your husband's puffer, it is more appropriate – especially when you are both in need – to have your own prescription.
It's important to note that a chronic cough can be caused by other conditions that are sometimes missed, including postnasal drip, allergic rhinitis, chronic obstructive pulmonary disease (COPD) and reflux or GERD. Therefore, a thorough evaluation is needed if your symptoms persist despite treatment.
Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.
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