Asthma: Managing Persistent Cough and Heart Concerns

Asthma issues

I would like to ask the doctor a few questions.
Since last winter, I have been coughing persistently.
I have visited many clinics, and the doctors have said it is due to allergies caused by changes in the weather, and that it would improve as the weather warms up.
Indeed, my symptoms improved when the weather got warmer, but not long after, the coughing started again.
I have a history of congenital asthma, and my family is very concerned that it might be an asthma attack.
However, after seeing the doctor, they said that the stethoscope did not reveal any recent issues, but my condition seems to be worsening.
The cough is relentless, and sometimes it makes me feel like vomiting.
I also experience severe nighttime coughing that disrupts my sleep.
My throat feels uncomfortable with a lot of phlegm, and I have dry mouth and thirst that persists despite drinking plenty of water.
Later, I started feeling fatigued, with weakness in my limbs, excessive sweating, and a constant feeling of heat (even in an air-conditioned room with just a thin blanket).
I also experience strong heartbeats (sometimes I wake up suddenly from sleep due to a strong thump in my chest).
I have read a lot online, and it suggests that it could be psychogenic asthma, which makes me worry about heart disease.
What should I do, doctor? P.S.: My mental state has improved a lot in recent days, and the weakness in my limbs has also improved, but the heartbeat issue has not yet resolved.

An, 20~29 year old female. Ask Date: 2022/10/03

Dr. Hong Yuanbin reply Internal Medicine

Hello, chronic cough can indeed have many causes.
The most important thing is to rule out lung and heart issues.
If auscultation is normal, the chances of severe asthma are lower, but there may be other lung problems.
It is advisable to consult a pulmonology or family medicine outpatient clinic at a larger hospital, where you may need to undergo X-rays and an electrocardiogram to confirm whether your heart and lungs are functioning normally.
Thank you for your inquiry.

Reply Date: 2022/10/03

More Info

Understanding asthma and its management, especially when accompanied by persistent cough and heart concerns, requires a comprehensive approach. Your symptoms, which include a persistent cough, feelings of fatigue, and episodes of rapid heart rate, can be indicative of several underlying issues, including asthma exacerbations, potential cardiac concerns, or even anxiety-related symptoms.

Firstly, it’s important to recognize that asthma is a chronic inflammatory disease of the airways that can lead to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. These symptoms can be triggered by various factors, including allergens, respiratory infections, cold air, exercise, and even emotional stress. Given your history of congenital asthma, it is crucial to manage this condition effectively to prevent exacerbations.

Your description of a persistent cough that worsens with weather changes and is accompanied by significant discomfort, including a sensation of phlegm in your throat, suggests that your asthma may not be well-controlled. The fact that your cough improves with warmer weather indicates a possible allergic component, as cold air can exacerbate asthma symptoms. However, the severity of your cough, especially if it leads to vomiting or disrupts your sleep, warrants further evaluation.

The symptoms of fatigue, excessive sweating, and a rapid heartbeat can be concerning. While these could be related to asthma or anxiety, they may also indicate a cardiac issue, especially if they occur during or after physical exertion. It’s essential to differentiate between asthma-related symptoms and potential cardiac problems. For instance, asthma can lead to increased heart rate due to hypoxia (low oxygen levels) during an asthma attack, but persistent heart palpitations or a racing heart, especially when not associated with exertion, should be evaluated by a healthcare professional.

Given your symptoms, I recommend the following steps:
1. Consult a Pulmonologist: Since you have a history of asthma, it would be beneficial to see a specialist who can perform a thorough evaluation, including spirometry (lung function tests) and possibly a methacholine challenge test to assess your airway hyperreactivity. This will help determine if your asthma is well-controlled or if adjustments to your medication regimen are necessary.

2. Monitor Your Symptoms: Keep a diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare provider in tailoring your treatment plan.

3. Consider Cardiac Evaluation: Given your concerns about heart issues, it may be prudent to undergo a cardiac evaluation, especially if you experience persistent palpitations, fatigue, or any chest discomfort. Tests such as an electrocardiogram (ECG), echocardiogram, or even a Holter monitor may be warranted to assess your heart's rhythm and function.

4. Manage Anxiety: If anxiety is contributing to your symptoms, consider discussing this with your healthcare provider. They may recommend cognitive-behavioral therapy or medications to help manage anxiety, which can also alleviate some of the physical symptoms you are experiencing.

5. Lifestyle Modifications: Ensure you are following a comprehensive asthma management plan, which includes avoiding known triggers, using inhalers as prescribed, and possibly incorporating a daily controller medication if needed. Staying hydrated and maintaining a healthy diet can also support your overall well-being.

6. Follow-Up: Regular follow-up appointments with your healthcare provider are essential to monitor your asthma and any potential heart-related symptoms. Adjustments to your treatment plan may be necessary based on your progress.

In summary, while your symptoms may be related to asthma, the presence of fatigue, heart palpitations, and significant cough warrants a thorough evaluation to rule out any underlying cardiac issues. A multidisciplinary approach involving both pulmonary and cardiac specialists will provide the best care for your situation.

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