Asthma – Understanding that Cough, Tightness and Other Signs


By Dr. Nina Radcliff

Do you – or someone you love – continue to have a dry hacking cough that seems it just won’t go away?  Does it seem to get worse after laughing, physical activities, or crying? Or, is there frequent coughing, especially at night? 

All of these are symptoms of asthma, an inflammation and constriction of the breathing tubes in the lungs that affects 26 million Americans (and approximately 7 million are children). According to a leading organization in this field, the American College of Allergy, Asthma and Immunology, your only symptom may be a dry, nonproductive cough; you may also experience difficulty breathing, shortness of breath, a tight feeling in the chest, or wheezing.  These symptoms must be tended too – and as quickly as possible by seeing your physician.

You may think you just have a cold or bronchitis (and you may) – but if your cough keeps coming back or is chronic, it may be asthma.  It is important to understand that while people with asthma often experience a whistling or wheezing sound in the chest in addition to coughing, there is a form of asthma in which the only symptom is a chronic cough. This is known as cough-variant asthma. People with this kind of asthma generally don’t get relief from over-the-counter cough medicine; successful treatment requires prescription asthma medication, often in the form of inhalers.

Again, it is vital to check with your physician if a cough lingers for more than two weeks or occurs repeatedly throughout the year.  Your lungs are trying to cough out what is bothering them and talking with you doctor is the first step to relief to find out the cause of the cough.

Dr. Nina’s What You Need To Know: About Asthma

What is asthma?  A serious, chronic lung disease in which the airways become inflamed and narrow. This hinders air movement into and out of our lungs and can manifest as coughing, wheezing (a whistling or squeaky sound), chest tightness, or shortness of breath. Uncontrolled asthma can also be life threatening.    

Our lungs consist of an intricate set of airways passages, or tubes, for air to move in and out, when we breathe. The goal of breathing is to inhale oxygen (essential for every single cell in our body) and exhale carbon dioxide (a waste product).

These airways are surrounded, and their diameter is controlled, by a special kind of smooth muscle that reacts to airflow velocity, hormones, and other signals. These smooth muscles are different than our biceps or hamstring muscles which we control. Those who suffer from asthma have airway muscles that “overreact” and constrict too tightly. This can set off a cascade of inflammation and swelling, as well as mucus production. The end result is impaired air movement in and out of our lungs.    

Who is affected by asthma?  Any one at any age can be diagnosed with or affected by the condition. Asthma often begins during childhood and may improve as the child gets older, requiring less or no medication. In those diagnosed as adults, it is possible that you had mild symptoms as a child.

What are risk factors for asthma? According to the American Lung Association, the most common risk factors are: having a parent with asthma (risk increases by 3-6 times); frequent respiratory infections as a child; an allergic condition (eczema, allergic rhinitis); or exposure to certain chemical irritants (industrial or wood dusts, chemical fumes or vapors, and molds). Additionally, cigarette smoking or second-hand smoke exposure and obesity are also risk factors.   

What is an asthma exacerbation?

Also known as an asthma attack or episode, it is when symptoms flare up and progressively worsen. Triggers can include allergens (dust, animal fur, mold, cockroaches, pollen); irritants (cigarette smoke, pollution, aerosolized sprays); certain medications (aspirin, beta-blockers); sulfites; upper respiratory infections; cold weather; and physical activity.

During an exacerbation, we see airway tightening that is accompanied by inflammation and mucus production. Without proper immediate intervention, it can quickly become dangerous– extreme shortness of breath, drops in oxygen levels, and fatigue from the increased work needed to move air—and even deadly.

How do I know if I or someone I know has asthma?

Along with the signs mentioned in the opening, common signs and symptoms include: coughing that is worse at night or early in the morning; wheezing; chest tightness; chronic, dry cough and shortness of breath. If you or someone you know is experiencing these, seek medical counsel. During your visit, your doctor will attain a medical and family history, perform a physical examination and may order lung function testing to make a diagnosis. 

It is challenging to diagnose asthma in children under the age of 5 years because there are a number of conditions that can mimic asthma symptoms (e.g., common cold, respiratory infections).

Is all asthma the same?

No! It is usually classified based on the frequency and severity of symptoms: intermittent, mild persistent, moderate persistent and severe persistent. Treatment plans are tailored to the type of asthma.

What are the types of medicines available?     

Most medications are in the form of inhalers because they can directly enter the site of action—your lungs. There are two main categories: long-term and short-term inhalers.

In persistent forms of asthma, your doctor will likely prescribe a daily, long-term corticosteroid control medication to prevent airway inflammation that causes symptoms in the first place. In other words, “stop the problem before it starts!” These long-term inhalers help prevent an exacerbation but are not effective at treating one.

Short-term inhalers are often termed “rescue” inhalers that can relax muscles around your airways during a flare-up. They are used during an exacerbation. In some instances, such as exercise or cold induced asthma, they may be prescribed before physical activity or going into the cold to dilate your airways. 

Oral steroids may be needed during severe exacerbations to decrease inflammation. And, too, allergy medications, such as over-the-counter antihistamines, saline rinses and decongestant nasal sprays, may help prevent an asthma attack.

Research and other advancements have made it possible for someone with asthma to live a normal, active life as well as sleep throughout the night. Like many illnesses, asthma requires the patient to take an active role in managing it, in order to be most effective. This includes avoiding triggers, taking medications as prescribed, seeking medical care early when an exacerbation hits and is not controlled, and establishing a strong partnership with your medical team.

And, too, consuming a balanced diet, maintaining a healthy weight, and decreasing stress are part of an overall approach to keeping asthma (as well as a myriad of other health conditions) at bay. What you eat makes a difference. Studies have shown that diets rich in vitamin D, healthy fats, fruit, and veggies, and low in saturated and trans-fats decrease inflammation in our bodies. As we discussed, inflammation triggers asthma symptoms.

As well, we know stress is bad for our health, and can be a trigger of asthma, similar to dust or pollen. While the mechanism is not completely understood, when we are stressed, we breathe harder and faster and our immune system is weakened.

Getting a proper diagnosis and creating – and maintaining – an asthma action plan (treatment) with your healthcare provider that is tailored to your symptoms are important steps to managing this chronic condition.

Dr. Nina Radcliff is dedicated to her profession, her patients and her community, at large. She is passionate about sharing truths for healthy, balanced living as well as wise preventive health measures. 

She completed medical school and residency training at UCLA and has served on the medical faculty at The University of Pennsylvania. She is a Board Certified Anesthesiologist and a member of the American Society of Anesthesiologists where she serves on committees for Young Physicians and Communications. Author of more than 200 textbook chapters, research articles, medical opinions and reviews; she is often called upon by media to speak on medical, fitness, nutrition, and healthy lifestyle topics impacting our lives, today.