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Could your winter cough be asthma?

Posted at 3:21 PM, Feb 04, 2016
and last updated 2016-02-04 17:30:46-05

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The following article is sponsored by the Intermountain Allergy and Asthma Clinic.

By Duane Harris, MD

In early January 2015, a 48 year old man came in for evaluation of a chronic, dry cough.  The cough had begun about 8 weeks earlier after a particularly bad ‘cold’, and although the nasal and sinus symptoms had resolved, the cough persisted.  The patient had taken three different courses of antibiotics, with minimal benefit.  The cough was worse in cold air, at night time, and especially after exercise.  The patient complained that the cough was interfering with sleep and with his ability to get back in shape after the holidays.  He remembered a similar, prolonged cough had happened the last two winters, but it seemed worse this year.  His primary care physician had become suspicious that this may actually be asthma and recommended that he see an asthma specialist.

When I examined this patient I heard very soft wheezing, and the patient immediately felt better after taking 2 puffs of a quick-acting inhaler.  I started him on a daily, maintenance asthma medication, and his cough was entirely gone 2 weeks later.  He was able to stop all medications during the summer.

This patient’s problem is fairly typical of adult onset asthma, which is generally triggered after a viral upper respiratory infection.  Adult onset asthma is often (but not always) seen in those who had asthma as a child and thought they had ‘outgrown it’, only to see the symptoms return later in life.  Adult asthma is frequently non-allergic in nature and can be much better, or entirely gone during the warmer pollen season.  Children who have asthma (whether allergic in nature or not) are also frequently worse during the winter.  Asthma flares are triggered by at least three things that we have in abundance in Utah during the winter: 1- cold, dry air; 2- poor air quality (inversion); and 3- viral upper respiratory tract infections.

I try to stress to my patients that the most important time for them to use their maintenance asthma medications regularly is during the cold winter months.  As an allergist, I think of two seasons: pollen season (March through October) and asthma season (November through February).  Of course depending on the patient, asthma can be bad at any time of the year, so if you have been advised to use asthma medications year-round, don’t stop just because the weather warms.

Of course, a prolonged cough isn’t always asthma.  Other problems that can produce a nagging, long term cough include a recent viral infection (even in some people without asthma), acid reflux (up to one third of people don’t feel ‘heartburn’ associated with their reflux), chronic sinus disease, post-nasal drainage from allergies, and other disease processes in the chest – including lung damage from smoking.  Finding the underlying cause of a chronic cough can be quite difficult in some cases, so a thorough examination and appropriate testing can be very helpful.

In summary:

  • If you have a prolonged cough in the winter;
  • If viral infections seem to linger for weeks;
  • If you have been diagnosed with recurrent bronchitis (and treated with multiple courses of antibiotics);
  • If you see a noticeable decrease in exercise ability during the winter;

You may have undiagnosed asthma.

Don’t cough all winter unnecessarily.  If you would like an asthma evaluation or more information about asthma and allergies, please call Intermountain Allergy & Asthma of Draper at (801) 553-1900Dr. Harris is a board-certified asthma and allergy specialist.