Expert: Marc Rubin, RPh Asthma Educator - 10/5/2008

Question
QUESTION: Is reactive airway disease the same as asthma?  For the past twenty to twenty five years (I am now 52), I have had "reactive airway" symptoms triggered by upper respiratory infections.  Sometimes a cold or sinus infection just remain a mild nuisance but at other times, I end up on inhallers.  Wednesday night (5am) I woke up feeling as if I was choking on mucous.  I had the worst coughing fit ever.  Once the coughing subsided, you could hear an audible wheeze with just about every breath.  I was planning on trying to go into work and if I continued to have breathing problems run over to the doctor.  My husband, who normally is not alarmed by health issues insited that we go to the emergency room.  When I got to the hospital, my pulse ox was about 91.  They gave me an oxygen mask for about thirty minutes to bring the oxygen levels up and then over a period of six hours gave me three breathing treatments and prednisone before discharging me.  The gave my RX for rescue inhallers, RX cough medicine and short burst prednisone.  Since comming home,  I had a mild occasional cough during the day- maybe seven or eight times an hour, very sore throat, headache and feel somewhat short of breath if I go down the steps etc. This evening, I selpt until about four am when I woke with coughing again.  I promptly took my cough medicine and rescue inhaller and am now sitting up and using saline nose drops to clear my nose out.  I have been coughing for the past hour, but no where near as bad as last night.  The wheezing is also much less than last night.  I was planning to go into work today, but may have to rethink that.  I have follow up appointemnt with my dr tomorrow.  In  the past, I could tell when I was starting to get bronchiospasms and would have enough time to get into the doctor before they got real bad.  This was the first time that I ended up in the emergency room.....quite scary.   

Are these symptoms typical of reactive airways?

I still think that I could have waited five or six hours to see my doctor.  How do you know when you should go to the ER vs wait to see the doctor?


ANSWER: Hi Amy,

These are symptoms of asthma. There was a brief period of time that it was called reactive airway disease, since we are learning that asthma itself comes in a number of genetic variants. But for all intents, that is a mute point.

I'm disappointed that with the history and presentation of symptoms you displayed at the ER, that upon discharge they didn't also give you a prescription for a controller medication to take on a daily basis.

I'm attaching a link to an "Asthma Action Plan" that helps to guide you by both symptoms as well as peak flow meter readings. This plan should be a product of your interaction with your physician. I strongly urge you to see an allergy/asthma specialist for a proper assessment of your lung health. You can locate a specialist through: http://www.aaaai.org/physref/

Also, I'm attaching a questionnaire that you should fill out and bring to the specialist when you have the visit. You should also use it as a periodic assessment of your lung health to use as a supplemental guide. It is at: http://www.asthmacontrol.com/

I hope this helps to guide you in the right direction. Should you have any more questions, please feel free to get back to me at any time.

Hope you are beginning to feel better.

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: Thank you for you help.  I plan to see an allergist that I had taken my son to in the past. He dx my son with pediatric habbit cough and got him off all meds within a month.  He was also spot on when he was sure that within a year, we would get a dx of gerd for my son.  Before joining a group of pulmonologists and allergists locally, he had worked at National Jewish Medical Center ranked 1 in respiratory diseases, such as asthma.  HE currently does leads other doctors in his practice in research studies and is an associate professor at a local teaching hospital and rated in Castle Connolly. I guess that if is not current, no one will be. I plan to get copies of the ER records and records from my doctor to bring to him. Keeping my fingers crossed. Thanks for your response

Answer
Hi Amy,

National Jewish and University of Wisconsin-Madison are the two premier centers for asthma research. Since your allergist is from NJMC, I'm sure he'll resolve your issues at present. What needs to be done beyond that though is personal education. Drug therapy is only 1/2 of the equation for attaining control. Having a full understanding of asthma, including the recognition of triggers and applying avoidance procedures, becomes paramount.

Good luck, and let me know how everything goes!

Marc