Asthma Arising in Adulthood

When a twenty-something athlete fell to the ground at a DC-area gym, he managed to say “asthma” and “can’t breathe,” but no one called 911 -- while his friend was at CVS buying an inhaler, the young man died. Asthma can be severely debilitating – and it can kill. But as with views of chronic fatigue syndrome and many other conditions, many people who have little personal experience of asthma -- either their own or that of someone close to them -- fail to take the condition seriously.

“It feels like an elephant is sitting on your chest,” said local filmmaker L.K., who always carries with her the prescription “rescue” inhaler albuterol. For DC-based development specialist R.C., several lengthy bouts of bronchitis in her early 60s led to diagnosis of non-allergic asthma – for which she began an ongoing daily regimen of two different medications and two different inhalers, one each for morning and night. (Inhalers for “rescue” or “relief” differ from “preventers” that can include long-acting bronchodilators.)

“The inability to complete a sentence without pausing for breath” is the often-missed clue that someone might be having a serious asthma attack, according to emergencyphysicians.org. Of three telltale asthma symptoms, the “classic” one is wheezing, a high-pitched whistling sound created by obstructed bronchial passages -- along with shortness of breath and cough.

Nonallergic asthma – comprising about one-third of asthma cases -- is more common in females and more severe than allergic asthma; and nonallergic asthma usually occurs after mid-life, also called adult-onset asthma. For nonallergic asthma flare-ups, exercise is an important trigger as is extreme weather – from winter chill to the heat of summer – along with stress and the common cold. Triggers for allergic asthma, the other main type or phenotype, include pollen and specific foods.

Repeated lung infections, such as bronchitis or pneumonia, can also lead to the development of nonallergic asthma. While the original cause of bronchitis is usually a virus or bacteria, repeated infections as well as long-term exposure to environmental irritants can result in chronic bronchitis. And when asthma and bronchitis occur together, the diagnosis is asthmatic bronchitis.

Asthma is “a chronic condition that causes swelling and inflammation in the lungs… accompanied by overproduction of mucus and spasm of smooth muscles that control breathing,” according to allergyasthmanetwork.org. As a result of inflammation and tightening muscles, the airways become narrower, and it becomes harder on the in-breath to get enough air. Wheezing and coughing are often efforts to draw in more oxygen through the tightened passageways.

Hormonal changes, GERD and heartburn, and environmental irritants such as perfume and smoke can all contribute to adult-onset asthma – as can new allergies that arise as the immune system becomes more sensitive with age. Evaluation of chronic symptoms by an allergist often starts with testing for specific allergens -- while pulmonologists usually begin with a physical exam, chest x-ray, and review of symptoms and medical history. Lung function tests, exercise testing, and evaluations for related conditions such as GERD can help with the diagnosis.

For non-allergic asthma, steroid medications are usually one part of long-term treatment -- in smaller doses than for acute infections and considered safe compared with the risks of developing severe asthma symptoms. Asthma kills about 10 Americans each day – with females more likely to die than males; and some 25 million people in the U.S—one in 13—live with the condition. In comparison, CVD (cardiovascular disease) causes almost 2500 deaths each day; and just over 400 people a day die from stroke. According to the Asthma and Allergy Foundation of America, “nearly all [asthma] deaths are avoidable with the right treatment and care.”

I learned a lot I had never known about asthma when recently I accompanied a family member to a pulmonology appointment. But I have always appreciated one piece of advice for sufferers, from washingtonpost.com: don’t make your bed. The article encourages those who regularly make their beds to go on doing so but concedes to “at least one argument against bed-making…dust mites love a neatly made bed.”