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Column originally published Aug 19, 2003

Adults With Asthma Have Same Triggers As Children

Question: 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 a lot of cough. 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?


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 by 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 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.