Asthma Unmasked

When is a cough not just a cough? Asthma, often mistaken for seasonal allergies, is a difficult disease to diagnose. Find out when you need to see a doctor and the best tactics to keep symptoms at bay.
by Stacy Lu
Allison Yerger was only partially breathing, but she didn’t know it. “I was coughing every night and waking up exhausted,” she says. Although the 41-year-old Metuchen resident had suffered from allergies due to pollen and dust since her 20s, it wasn’t until she mentioned her two-year-long cough to her son’s allergist that she discovered she had asthma. “My doctor said, ‘Why didn’t you tell us about that cough?’ She tested me and found that my lungs were working at only 60 percent capacity and said, ‘No wonder you’re tired — you can’t breathe!’” Yerger recalls.

Asthma seldom behaves the way it does in television commercials or movies: a sudden dramatic attack of complete breathlessness, hopefully followed by rescue from an inhaler. Sometimes asthma causes wheezing, day and night. More often, it shows itself less dramatically as a nagging cough, constant chest congestion, or an inability to sustain a long breath or sentence.

No matter how obvious the symptoms, though, asthma’s persistent inflammation can permanently damage the lungs if left untreated. The disease is also particularly dangerous during pregnancy, as airflow to both the mom and the unborn child is compromised.

According to the New Jersey Department of Health and Senior Services, 10 percent of women and 10 percent of children in New Jersey suffer from asthma. (The number of women with asthma is almost double that of men.)

Causes are not clear, but genes play a role, as do environmental exposures. Just one bad viral infection, even as an adult, can result in asthma. Yet as common as it is, the disease can be difficult to diagnose and manage. Complicating matters is the fact that at least half of all asthma patients have symptoms set off by allergens, like pollen from weeds, trees, and grass; dust; certain foods; and animals. Particularly in the case of seasonal allergens, problems are periodic, temporary, and often misnamed or neglected.

“People don’t repeatedly get sick in their chest if they are a nonsmoker. But we hear it all the time: ‘I just get that seasonal cough,’” says Ellen Sher, M.D., of Atlantic Allergy, Asthma, and Immunology Associates of New Jersey, in Ocean. “If they tell me they get bronchitis every spring, well, that’s seasonal asthma.”

Coughing is particularly likely to be the only symptom seen in children, says Arthur J. Torre, M.D., a pediatric allergy and asthma specialist in Fairfield. “Kids are more resilient,” he says. “They will be coughing for a long time, and we think it’s a cold. Nobody hears them wheezing. That’s how it gets missed.” About half of all pediatric asthma cases, Torre estimates, are undiagnosed or misnamed.

Consulting an allergist for recurring symptoms is a good first step, but identifying triggers can be tricky. Following multiple tests, an allergist diagnosed Erin McCloskey of Delran with multiple food allergies after the then 15-month-old wheezed night and day.

“She was allergic to basically everything we were feeding her: wheat, eggs, soy, tomato, squash, milk,” says her mother, Natalie. “And she’s still developing new allergies: to makeup and some preservatives that doctors still can’t put their fingers on.”

Environmental triggers can be even harder to pinpoint, and unfortunately, New Jersey has more than its fair share of them. “We have the worst of both worlds from an asthma point of view. We have tons of pollution from cars, trucks, and industry, and we have lots of pollen,” Torre says. “Plus, when we disturb the ground, we get more weeds — and we do a lot of construction in this state.”
Sidestepping lifestyle triggers may do the trick for many asthma patients, but seasonal allergens are virtually impossible to avoid. Managing asthma symptoms, then, is critical, and it makes sense to consult a specialist for a chronic respiratory symptom. It wasn’t until McCloskey consulted a pediatric pulmonologist that her daughter’s symptoms finally eased, she says.

“Our pediatricians were great, but they were at their wits’ end. They thought Erin’s asthma should respond to the regular medications, and it didn’t,” she says. “We couldn’t even get from the house to the car without her wheezing. We were wondering, ‘What kind of life was she going to have? She can’t go outside. She can’t go out to eat.’”

The good news is that once a patient is diagnosed, the widening range of new asthma medicines — from inhaled steroids and combination steroid/bronchodilators, to allergy shots for more serious cases — can work wonders if correctly and consistently administered.
“The goal is to find what’s going to work with an individual patient to keep them under control,” Torre says. “We do whatever it takes.”

For more on asthma programs and services, visit the website of the Pediatric/Adult Asthma Coalition of New Jersey at pacnj.org.

Find an Allergist

An allergist is a doctor with at least? two additional years of specialized ?training in the diagnosis and treatment ?of allergies, asthma, and autoimmune diseases, as well as the evaluation and treatment of patients with recurrent infections, such as immunodeficiency diseases. Visit the American Academy ?of Allergy Asthma & Immunology’s ?website at aaaai.org/physref and use ?its physician locator to find an ?allergist near you.

Seasonal Allergen Triggers

Preventive Measures
Use the following tips to help ward off the symptoms of common seasonal allergens and triggers.
Pollen. As good as warm spring air feels, it also spreads the biggest culprit for seasonal symptoms. Close your house and car windows, run the air conditioner, vacuum often, wash rugs and drapes, and shower in the evening to help keep bedclothes pollen-free. Repeat during the summer grass and fall ragweed seasons, if needed.

Exercise. While many of us head outdoors for spring training, strenuous exercise in dry, still-crisp air can bring on asthma symptoms, even if you have no other triggers. Talk to your doctor about how to control exercise-induced symptoms. If you know you have seasonal allergies, consider working out indoors when allergens are rampant.

Pesticides. Do not use aerosol sprays or foggers, which can irritate your lungs. “Anything that you’re spraying into the air, you’re able to breathe in,” says Arthur J. Torre, M.D., a pediatric allergy and asthma specialist.

Outdoor mold. Mold thrives in shade, compost, and rotting trees from early spring until the first frost, and, like pollen, is wind-borne. Use a dehumidifier or air conditioner to reduce moisture, keep your yard free of debris, and wear a mask while gardening or doing yard work. Vent your bathroom and kitchen while bathing and cooking.

Related Reading

» Asthma and Women: In New Jersey, the number of women with asthma is almost double that of men. Get the facts about women and asthma, plus a state resource list from the Department of Health and Senior Services.
» Download an Excerpt from Asthma Free, Naturally by Patrick McKeown
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