Asthma: Pay attention to the mild symptoms
19 August 2003
Q. I was diagnosed with asthma many years ago. I don't
get asthma attack, and I use a blue puffer from time
to time only when I find it hard to breathe, or when
I get a cold and cough a lot. I am generally healthy
and hardly see my family doctor. In the last few years
I have joined a choir. One troubling problem is that I
have a lot of phlegm. I don't normally cough, but I have
to bring the phlegm up quite often. This problem bothers
me when I sing. Is it related to my asthma, and is there
something that I can do about it?
A.
You have a very interesting question. Whether your
phlegmy condition is because of asthma or not can only
be determined by your doctor. There are many medical
conditions that can make a person phlegmy, asthma is
definitely one of them. Let me begin by explaining in
more detail about asthma and its symptoms.
Asthma is essentially an allergic condition of the
bronchial tubes in the lungs. People with asthma are born
with sensitive bronchial tubes, although asthma symptoms
may not appear until later in life. The bronchial
tubes can be sensitive to many triggers in the home
environment, including house dust mites, mildew, animal
dander, cigarette smoke, and chemicals. Allergy to outdoor
triggers like pollen and moulds are usually more seasonal.
Colds due to viruses and some bacterial infections can
also trigger asthma symptoms.
Most people only recognize asthma when a person has an
asthma attack. During one of these episodes, he may
have shortness of breath, cough, and sometimes wheezing.
Most of the time the person can cough up mucus, although
on occasion the bronchial tubes can become so tight that
mucus cannot come out. If the attack is mild, he can
gradually improve after several days or weeks. However,
if an attack is severe, he will need medical attention.
Every year, many asthmatics in North America still die
from asthma because they did not receive proper medical
treatment soon enough.
What is not commonly recognized is that most people
only have occasional asthma attacks, often triggered by
exposure to something that they are very allergic to, or
as a result of respiratory infection. In between these
attacks, many of them continue to be affected by triggers
in their environment, although to a much smaller degree.
As a result, the symptoms are much milder. There may be no
shortness of breath unless you exert yourself with running,
biking, or other more strenuous exercise. Your bronchial
tubes will react to the triggers by producing mucus,
which is slowly pushed up into the trachea and back of
the throat. When it reaches the trachea, you will have
the feeling of phlegm there. You can remove the mucus by
coughing or clearing of the throat. Because only a small
amount of mucus come up every time, most people would not
even recognize the problem. You might not have noticed
it if it didn't affect your singing.
Another symptom that you may notice is difficulty taking
a deep enough breath, and this can affect your singing.
Some adults with asthma also wake up in the middle of the
night because of cough, and this can affect their quality
of sleep and make them tired during the day.
Many people with asthma also have allergy symptoms in the
nose, like nasal congestion, sneezing, or post-nasal drip.
Others suffer frequent sinus infections. Whatever that
affects the lungs can affect the nasal passage, since air
has to pass through the nose before entering the lungs.
Those who are mouth-breathers often have chronic nasal
congestion (that is why they breathe through the mouth),
and many of them have nasal allergies. Therefore,
watching symptoms of nasal allergy can provide some clues
for asthma.
Since you know that you have asthma, it is advisable that
you try to improve your home environment and reduce some
of the triggers. If you have to burn wood in winter as a
source of heat, try to pile the wood outside because wood
carries mildew into your home. Many basements are fairly
damp during summer time, a dehumidifier can reduce the
humidity and prevent mildew from growing there.
If you have carpets inside, they are great to trap
house dust mites which can trigger asthma. I believe
wall-to-wall carpet is one of the worst human inventions.
Removing carpets can often reduce asthma symptoms.
Pillows and mattresses (as well as other non-washable items
in bed) collect dust mites also. You can buy plastic zip
covers to seal them and reduce mites. I also recommend
parents remove teddy bears or wash them weekly if their
children have asthma. Teddies are also great collectors
of dust mites.
Forced-air heating circulates dust through the house
more than hot-water or electric heat. Cleaning the
heating ducts by professional duct-cleaners can reduce
dust circulation. Putting high efficiency filters at
the furnace as well as filters at the vents can further
reduce dust mites. Some air-cleaners with HEPA filters can
remove dust in bedrooms. I also recommend turning down
the thermostat (and put on a sweater) during winter can
reduce energy consumption as well as circulation of dust.
If you use a lot of chemicals indoors (including sprays,
air-fresheners, and scented candles), reduce them to the
bare minimum. All smokers should go outside to smoke,
and never in the car. Better yet, they should all quit,
because they still carry enough smoke afterwards on their
body that can affect those with asthma. We are fortunate
that our government had enacted legislature that outlaws
indoor smoking in public places.
If you are affected by pollen and mildew from outside,
there are still a few things that you can do before moving
to the desert. If you hang clothes and sheets outside, it
is not a good idea because they do trap pollens and mildew
which will be brought indoor. Putting them through washer
and dryer can reduce your exposure, although you would have
to use more energy. If you have air-conditioning at home,
it can filter out pollen and mildew. Keep the windows
closed early in the morning can also reduce pollen from
entering your home.
In addition to improving your environment, you should
be glad to know that there have been major advances in
medical treatment of asthma. There is nothing that can
cure asthma at the present. However, medications can
keep the bronchial tubes more healthy and less sensitive
to triggers. The blue puffer that you have been using
likely is a bronchodilator, a medicine that relaxes the
muscle around bronchial tubes. It can make you feel better
if you have trouble breathing, however, it doesn't really
help to make your asthma better.
Inhaled steroids, on the contrary, can reduce swelling of
bronchial tubes and production of mucus, both of which
are hallmarks of asthma. Using inhaled steroids on a
daily basis can reduce asthma symptoms and allow healing
of bronchial tubes to occur. After a period of time,
the airway would become more stable and triggers do not
affect the bronchial tubes as easily. Low dose inhaled
steroid is very safe and has no harmful effect on other
parts of the body.
A new class of medicine called leukotriene antagonist has
become available in North America in the last few years.
They work by preventing the formation of chemicals called
leukotrienes in the bronchial tubes, almost like stopping
asthma in its track. They are available as pills taken
every day. Most children with asthma do benefit from this
type of medicine, although its effectiveness in adult is
somewhat lower.
I would suggest that you pay more attention to the asthma
symptoms that I have listed above, and make an appointment
to see your family physician. Explain to your doctor
what you feel, and what seems to make your symptoms worse.
Your doctor may decide to do further investigation to make
sure that you don't have other medical conditions.
One thing I should mention here is that your doctor may
not be able to detect any abnormality in your lungs by
examination. This is very common when you are not having
an asthma attack, your doctor cannot hear any wheezing
noise in the chest which is characteristic of asthma.
Chest X-ray is not very helpful most of the time.
The best investigation for asthma is the lung function
test, although some asthmatics still have normal results.
Sometimes the best test is to use inhaled steroid daily
for several months. Those patients with asthma usually
improve significantly. Some may require treatment for
nasal allergies at the same time.
I hope this information is useful to you and others
with asthma. No one should suffer from asthma any more,
although successful treatment requires close attention to
your environment as well as medicine.
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