|After Adolescence, Asthma-Like Symptoms May Not Be Asthma||| Print ||
|Wednesday, 22 February 2012 15:31|
By Navdeep Singh, M.D.
SPECIAL TO THE FORUM
Most of us recognize episodes of wheezing, coughing and difficulty breathing as bronchial asthma, a long-term disease of the lungs affecting more than 24 million U.S. adults and children.
When these symptoms begin in adulthood, though, the likelihood of the underlying cause being a more serious condition instead of asthma is significantly higher.
Seventy-five percent of asthma patients develop symptoms before age 12, and fewer than 10 percent develop symptoms in adulthood. However other diseases, such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF), can mimic asthma’s symptoms and are more common in adults than children.
An asthma attack occurs when the smooth muscle surrounding the air passages in our lungs contracts, narrowing the passageways and making it difficult to breathe, so asthma treatments either reopen the airway during an attack or help prevent attacks from occurring.
When a patient’s symptoms are caused by a different condition, though, different treatments are needed.
Vocal cord dysfunction (VCD) is most commonly diagnosed in adults between the ages of 20 and 40, and its symptoms can mimic asthma almost perfectly.
During normal respiration, the vocal cords open completely to let air pass in and out of the lungs. In patients with VCD, the vocal cords will sometimes close when they should open—producing a wheezing-like sound and making it difficult to breathe.
Because the vocal cords do not respond to asthma medications, asthma treatments won’t help patients with VCD and can, in fact, make an attack worse.
Other potential causes of asthma-like symptoms include COPD, lymphoma, CHF and a tumor in the airway. In some cases, asthma can coexist with one of these conditions, sometimes making the second condition less apparent.
Managing an attack
Anytime our ability to breathe is threatened, panic can set in, and that can make an attack even worse. To manage attacks effectively, patients need to have an action plan that is specific to them and their disease.
For asthma patients, action plans generally include identifying and avoiding asthma triggers (e.g. cold air, exertion or dust and other allergens), as well as instructions on what to do when an attack occurs.
For patients with VCD, plans typically include steps to address any underlying cause and learning exercises taught by speech therapists that can help relax the muscles in the throat and open the vocal cords.
Patients and their families should also learn to recognize when it is time to call 911. Difficulty in breathing can be life threatening, and a patient’s best chances come with a fast response.
If you are alone when calling 911 and cannot speak, tap the telephone on a hard surface such as a table or counter. 911 operators are trained to recognize that as a sign of a patient who is choking and will dispatch medical responders right away.
Know your disease
As with all conditions, the best resource a patient has is knowledge. Understand your disease, what triggers it and how to manage it. Also, seek treatment early.
Left untreated, asthma and similar disease can become far more serious and difficult to treat.
Navdeep Singh, M.D., is a triple board certified internal medicine, pulmonary disease and critical care medicine specialist affiliated with Eden Medical Center.