Expert: Marc Rubin, RPh Asthma Educator - 7/12/2009

Question
There are a few reasons that I'm wondering this. I described these symptoms
to a friend who is a medical student recently and he thinks I have
undiagnosed asthma, but I'm not sure.

Firstly, ever since I was very young, I've had bad coughs almost every winter.
This has happened almost every year for as long as I can remember (I'm 18
now) for about a month each time. I don't remember whether my parents
took me to my regular GP about this, but they tried various homeopathic
treatments which never made the slightest difference.

When I was about 12 I started to get allergies, and I still don't know what I'm
allergic to, but I regularly have irritation in my nose, eyes, ears and throat. I
also get mildly wheezy when this happens. I went to the doctor and he asked
if I had any family members with asthma. I said no, so he said that it was
probably just hayfever and sent me away.

The other problem is that every time I have a cold, it turns into a chest
infection, which usually lasts a couple of weeks. I don't think I've ever had a
cold which didn't end up with me getting a really bad cough.

So I guess my question is, does it sound like all this is caused by mild asthma
which was never diagnosed? I'm otherwise fit and healthy. I live in the UK. Oh
and I live in a city. Thanks!

Answer
Hi Anna,

Although many people are under the impression that the predominant symptom with asthma is wheezing, in reality, especially in children, it is coughing. The airways become inflamed, and therefore narrower. Combine that with increased mucous secretions (phlegm, and you have the cough of trying to clear the airways due to the fluid causing obstruction.

Oh, "it is probably just hayfever", ah... an allergic condition, and in children, allergic conditions are the foundation of most of the asthma we see. Hope you won't go to him anymore. He certainly didn't earn his copay.

Asthma is a variable illness. It may be seasonal, or continuous. Respiratory viruses are a major trigger of lung inflammation, and we see more of them in the winter. Your medical presentation warrants a proper evaluation to assess the presence of asthma. The doctor should be doing the following:
1) a complete medical history, so bring as much info as you can put together,
2) a physical exam of not only listening to your lungs, but looking into your sinuses, ears and eyes,
3) a blood test (CBC with differential). The differential will provide the levels of eosinophils, a type of white blood cell that is elevated in people with allergic issues,
4)a spirometric lung test with methacholine challenge, which looks for lung reactivity, or at least repeating the test after a dose of albuterol, where we look to see at least a 12% improvement in lung volume. The problem with the latter is, since we are no longer in the winter season where you have more problems, the answer may not be clear.
5) an allergy blood test called a "RAST" test. Gives a decent reflection of allergic tendencies. If your eosinophils are elevated, and you have a positive RAST test, then I'd want to see actual sksin testing done to better identify your triggers.

With these steps completed, you should have a clear answer to your question. If it comes back that you do have asthma, get back to me and I'll guide you to educational resources so you can learn how to take control.

I hope this helps to lead you to your answer.

Sincerely,

Marc