A persistent cough may be more than just a cold that lingers — it could signal adult-onset asthma.
We often associate asthma with childhood, but this disease of struggling breath can strike at any age.
“I’ve seen people in their 80s present with their first episode of asthma,” says Dr. Gary Alexander, pulmonary expert at Tanner Clinic.
When it hits, you know you’ve come down with something — you’re coughing constantly and short of breath. Your chest feels so tight.
“It gets your attention,” he says.
But often, people who think they’re too old to get asthma may mistake these symptoms for, say, an upper respiratory tract infection.
Sometimes, the symptoms are even confused with congestive heart failure.
Diseases of the lung are Dr. Alexander’s specialty, and over the 16 years he’s been at Tanner Clinic, he’s seen the entire spectrum. He sees patients for pulmonary fibrosis and pulmonary hypertension. Many of his patients suffer from sleep apnea; less often cystic fibrosis.
And sometimes, asthma is the diagnosis. “Often they come in when they’re short of breath and they’ve been that way for a while,” said Dr. Alexander. “They say, ‘Why can’t I breath?’”
When diagnosing asthma or a similar disease, Dr. Alexander looks for these symptoms:
▸ Shortness of breath
▸ Chest tightness
▸ Constant coughing and wheezing
▸ Phlegm (mucus) production
▸ Fatigue and frequent colds
Like COPD — chronic obstructive pulmonary disease including emphysema and chronic bronchitis — asthma is a condition where air is obstructed from flowing freely in and out of the lungs.
Generally, it’s inflammation that causes the obstruction, exacerbated by triggers like pollen, pollution and little kittens. Here in Utah, autumn wildfires and January’s inversions cause an increase in office visits.
Trying to catch a breath
Childhood asthma and adult-onset asthma have the same “disease process,” says Dr. Alexander. But the triggers may differ.
A large part of asthma treatment for adults, he says, is minimizing exposure to those triggers — when you’re able to identify what they are. Allergies are a place to start, or a patient’s history. Sometimes the triggers cannot be identified.
Oddly, the problem is not that people with asthma can’t breathe in enough air — they can’t blow enough out.
Asthma patients generally have normal lung volume, said Dr. Alexander. “But they can’t breath out as quickly as they’re supposed to. Because of that, you get a sense of air trapped in the airways.”
Dr. Alexander started out as an engineer — he has a master’s degree in environmental engineering from the University of Utah. He was partly through his engineering classes when the medical bug hit him. He finished his engineering studies anyway, following advice to “get a degree in something you enjoy because if you don’t get into medical school, you still have to make a living.”
After his years at Tanner Clinic, he’s concluded that medicine isn’t nearly as ordered and cut-and-dry as engineering. “There’s more art in medicine than engineering,” he says.
Sleep medicine is a natural subcategory of the pulmonary specialty because, he says, “so much of sleep medicine is sleep apnea, and that’s a disorder of breathing during sleep.”
Researchers aren’t sure why asthma hits at any age. “If we knew that, we’d be better at preventing it,” says Dr. Alexander.
Depending on the symptoms and the degree of severity, asthma can be a big detriment to lifestyle. “That’s ultimately the goal of treatment,” says Dr. Alexander, “managing symptoms such that they don’t interfere with patients’ daily activities.”