Cough-Variant Asthma: Symptoms, Diagnosis, and Treatment

About Asthma

I have been experiencing discomfort in my nose and chest.
After a physical examination, the doctor diagnosed me with a cold and chest discomfort caused by the cold.
After taking medication for three days, I still felt unwell.
During my follow-up visit, the doctor mentioned that I would improve within a week.
This was stated twice, so I tried to cope with it.
However, after some time, I still felt uncomfortable and went back for another check-up.
This time, the doctor had me blow into a spirometer three times and diagnosed me with asthma.
I used an inhaler for three months, but my nasal issues were not resolved, leading to some post-nasal drip, which occasionally caused me to cough.
The doctor always asked if I was coughing, and I mentioned that it was infrequent.
I mostly felt chest tightness; even though I could take a breath, my chest still felt uncomfortable.
The doctor referred to this as "cough-variant asthma."
After researching "cough-variant asthma" online, I found that the main symptom is coughing.
However, I cough very rarely.
During my follow-up visit, I asked the doctor why it was classified as "cough-variant asthma." The doctor explained that the same individual may present with coughing during one episode and chest tightness during another.
Since the onset of my symptoms, my experience has been that I can breathe in, but my chest remains uncomfortable, along with nasal issues.

After three months of treatment, I had three follow-up visits using a disposable peak flow meter, and my readings never reached 80%.
There were slight improvements and regressions, and I was told I had "moderate persistent asthma." The doctor had me sign a paper regarding my asthma, but I only saw the signature line, as other papers were covering it.
I assumed it was fine to sign, so I did.
Asthma is a chronic condition, and I thought I would receive a chronic prescription, but instead, I had to return for three consecutive months to get three types of medication: an inhaler, an allergy medication, and another pill I forgot.

Currently, I am not using any medication, and the doctor advised me to return if I catch a cold.
The doctor informed me that I have asthma but did not provide further information, so I had to research asthma knowledge on my own.
I asked the doctor what my standard values were if I bought a peak flow meter to measure my readings daily, but the doctor said it was simpler to discuss in percentages, so I still do not know my baseline and did not purchase one.

Visiting a large hospital is inconvenient, so I go to a clinic where this doctor specializes in pulmonary issues and has the necessary equipment for lung function tests.
I can only visit on Saturdays, but it seems that the clinic may be closing on Saturdays soon.
If I switch to a more accessible ENT clinic, would that be acceptable? (1) Almost every ENT clinic states they can manage asthma.
(2) Although it's unlikely, I still want to ask if I would be diagnosed with asthma again if I went to a large hospital for further testing.
(3) I still occasionally feel unwell, but I plan to wait until it becomes unbearable before seeking help.
Thank you for reading this lengthy message.

Niming, 20~29 year old female. Ask Date: 2017/09/25

Dr. Jian Shuntian reply Pulmonology

Based on your description, it is possible that you have asthma.
It is advisable to visit a pulmonologist for further confirmation.
A peak flow meter should first be used to determine your personal best value (the best value when asthma is fully controlled).
The emergency inhaler is for use during sudden attacks.
It would be best to seek assistance from a pulmonologist.
Thank you.
Sincerely, Jian Shun Tian.

Reply Date: 2017/09/25

More Info

Cough-variant asthma (CVA) is a subtype of asthma where the primary symptom is a persistent cough rather than the more typical wheezing or shortness of breath. This condition can often be misdiagnosed or overlooked, especially in patients who do not exhibit the classic symptoms of asthma. Your situation, where you experience chest discomfort and a cough that is not frequent but still bothersome, aligns with the characteristics of CVA.

In your case, the initial assessment by your doctor suggested that your symptoms were due to a common cold and its complications. However, after further evaluation, including spirometry tests, your doctor diagnosed you with asthma, specifically CVA. This diagnosis can be confusing, especially since you mentioned that you do not cough often. It is important to understand that asthma can manifest differently in different individuals. For some, the cough may be the only noticeable symptom, while others may experience wheezing or chest tightness.

The fact that you have a history of allergic conditions and nasal issues, such as post-nasal drip, can contribute to your respiratory symptoms. Allergies can exacerbate asthma symptoms, and post-nasal drip can irritate the throat, leading to coughing. It is also noteworthy that your symptoms seem to worsen at night, which is a common characteristic of asthma, as airway inflammation can increase during sleep.

Regarding your treatment, it is essential to follow your doctor's recommendations and use the prescribed medications consistently. Inhaled corticosteroids and bronchodilators are commonly used to manage asthma symptoms and reduce inflammation in the airways. If you have been using a rescue inhaler or a maintenance inhaler, it is crucial to understand how and when to use them effectively. Your doctor should provide you with a written asthma action plan, which outlines how to manage your symptoms and when to seek further medical attention.

Monitoring your peak expiratory flow (PEF) can also be beneficial. While your doctor mentioned using percentages, it is important to establish your personal best PEF value when your asthma is well-controlled. This value can serve as a reference point to help you recognize when your asthma may be worsening. If you are considering purchasing a peak flow meter, it can be a valuable tool for tracking your lung function over time.

As for your concerns about switching to an ear, nose, and throat (ENT) specialist, it is generally acceptable to seek care from a specialist who has experience managing asthma, especially if they are familiar with allergic conditions. However, it is advisable to find a healthcare provider who can perform comprehensive asthma assessments, including spirometry and PEF monitoring.

If you are contemplating returning to a larger hospital for further evaluation, it may be beneficial, especially if you feel that your symptoms are not adequately managed. A thorough assessment can help rule out any other underlying conditions and ensure that your asthma is being treated appropriately.
In summary, cough-variant asthma can be challenging to diagnose and manage, particularly when symptoms are not typical. It is crucial to maintain open communication with your healthcare provider, adhere to your treatment plan, and monitor your symptoms closely. If you continue to experience discomfort or have concerns about your asthma management, do not hesitate to seek further evaluation or a second opinion. Your health and well-being are paramount, and proactive management of your condition can lead to improved quality of life.

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