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Can Asthma Symptoms Be Something Else?

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How Seasonal Allergies, COPD, Postnasal Drip and GERD Can Cause the Same Issues

Posted by Sean P. Duffy, MD

Many of the patients who make an appointment to see me do so because they’re having trouble breathing or they’re frequently wheezing or coughing.

Often the issue turns out to be asthma. But, there are many other conditions that can cause similar symptoms. It’s my job as a pulmonologist to figure out the cause of their symptoms and to develop a personalized treatment plan that will help them breathe better.

When discussing with patients the many different conditions that could be triggering their symptoms, I start by explaining each of the conditions and how they may impact their health. I often kick off the discussion with asthma.

What is asthma?

Asthma is a chronic condition where your airways become narrow and inflamed. This can cause symptoms such as:

  • Shortness of breath
  • Wheezing
  • Wet or dry cough
  • Chest tightness
  • Rapid breathing

Asthma symptoms are usually set off by a trigger. Cold air, exercise, allergies and viral infections — like colds — are common culprits. For some people, even laughing or crying can bring on an asthma attack. Many patients also tell me their asthma symptoms are worse early in the morning or at bedtime.

If you have asthma, following a treatment plan can help you feel much better. This often includes taking long-term and short-acting medications, and making lifestyle changes to help avoid your triggers.

Treatment can also help keep asthma from getting worse over time. And that means you can do more of the activities you love.

What can be mistaken for asthma?

Other problems can sometimes mimic asthma. For instance:

GERD (Gastroesophageal Reflux Disease)

GERD is caused by acid from the stomach flowing up into the esophagus. It’s commonly described as heartburn. People who have GERD experience symptoms of heartburn 2 or more times a week. This burning feeling in their chest and throat often happens after eating certain foods or drinking certain beverages. Over time, the backwash of stomach acid may damage the esophagus.

Although GERD is not an actual lung disease, it can cause complications outside the esophagus: in the mouth, throat or lungs. These complications may include a chronic cough, hoarseness and wheezing.

COPD (Chronic Obstructive Pulmonary Disease)

COPD is an umbrella term that refers to a group of lung diseases, including chronic bronchitis and emphysema, that get worse over time and make it hard to breathe.

Many of my patients with COPD have both emphysema — in which the air sacs in the lungs become damaged — and chronic bronchitis — in which the lining of the airways stays constantly irritated and inflamed, causing the lining to swell.

COPD can cause:

  • Chest tightness
  • Coughing
  • Wheezing
  • Shortness of breath
  • Excess mucus

COPD and asthma both cause obstructive lung disease, making it hard to get air out of the lungs. This makes breathing difficult. The difference is that asthma is reversible, can get better over time, and its symptoms are typically not constant — they may come and go.

Symptoms of COPD, on the other hand, are constant and often get worse over time. Asthma also can affect people of any age. It’s a common condition in children. My patients who develop COPD are usually 40 or older.

Postnasal Drip

Postnasal drip — an accumulation of thick mucus in the sinuses that runs down the back of the throat — can be a symptom of many different conditions, including:

  • Asthma
  • Allergies
  • GERD
  • Cold
  • Flu
  • Sinus infection

It can trigger a cough and a sore, irritated throat. Postnasal drip can also be caused by other factors, including:

  • Medications that thicken mucus
  • Cold temperatures
  • Bright lights
  • Certain foods and spices

Seasonal Allergies

People with asthma many times also have seasonal allergies that may cause:

  • Wheezing
  • Sneezing
  • Stuffiness
  • Runny nose
  • Itchiness of the mouth, throat, nose, eyes or ears
  • Shortness of breath

Seasonal allergies, often called hay fever, are most often caused by pollen and mold spores in the air.

In the early spring, pollen may come from trees, while in late spring and early summer, grasses are often the culprit. Later in the summer and fall, weeds are a frequent source of pollen.

Mold spores are found almost anywhere outdoors, including in soil, plants and rotting wood. Common sources of indoor mold include old books, and bathrooms and other damp areas in a home.

Each of these above conditions requires different treatments, and it’s possible to have more than one of these conditions at a time.

Getting the right diagnosis

If I think that someone may have asthma or another condition that is causing their symptoms, I’ll start by asking them a series of questions that will help me get to know them better and diagnose their condition. For example:

  1. What are your symptoms? When do they occur? How often do they occur? Are they worse at a particular time of day or when you’re relaxing?

  2. If you cough a lot, does it sometimes make you wheeze or make it hard for you to catch your breath?

  3. Do you belch a lot?

  4. What activities do you enjoy? Do you have any breathing problems while participating in those activities?

  5. What kind of work do you do? Are you exposed to any pollutants that might affect your breathing or make you cough or wheeze?

  6. Do you have pets in the home or are you regularly exposed to animals?

  7. Do you have a family history of asthma, allergies or COPD?

  8. Do you have a personal history of asthma, allergies, heartburn or COPD?

  9. Have you ever been diagnosed with COVID-19?

  10. Have you ever been tested for tuberculosis?

  11. Do you currently smoke, or do you have a history of smoking, including any type of tobacco product or recreational drug, such as marijuana? If so, how often and how much? When did you quit?

  12. Do you drink alcohol? If so, how often and how much?

  13. What medications do you take, including over-the-counter medications, vitamins and herbal supplements?

  14. Have you ever needed to visit an emergency department because you were having trouble breathing?

After discussing a patient’s answers to these questions, I listen to their breathing. I’ll also run tests that measure their lung function. I might also order other tests, such as blood work, a chest X-ray or a CT scan.

Once I have the results of those tests and discuss the results with the patient, then together we design a plan for better breathing.

Find out what’s triggering your symptoms

To get to the bottom of your symptoms, make an appointment at the Temple Lung Center today. Or call 800-TEMPLE-MED (800-836-7536).

Sean P. Duffy, MD

Dr. Duffy is a pulmonology and critical care specialist at the Temple Lung Center, with expertise in chronic obstructive pulmonary disease (COPD), sarcoidosis, interstitial lung disease and cough. An Associate Professor of Clinical Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University, Dr. Duffy is also a member of the American Thoracic Society.

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