Asthma and Other Lung Diseases

Asthma and Other Lung Diseases

Also called: Asthma Related Breathing Problems

Summary

Asthma is a chronic (ongoing) inflammation of the airways that affects the breathing patterns of millions of people. The disease is highly treatable, but difficult to diagnose because no single test detects it. In addition, many other lung diseases share symptoms with asthma, further complicating diagnosis.

There are several diseases that mimic asthma and thus complicate a physician’s ability to make an accurate diagnosis. This is especially true in adults. Chronic obstructive pulmonary disease (COPD), a disease usually caused by years of smoking, sometimes has symptoms that make it very difficult to distinguish from asthma. Other disorders, such as bronchitis and cardiac asthma, also can be misdiagnosed as asthma.

The task of correctly diagnosing children is usually a bit easier. Diseases that mimic asthma in children – such as cystic fibrosis (a glandular disorder that affects the lungs) and bronchiectasis (damage to the bronchial tubes) – often can be confirmed through testing. A pattern of episodic coughing (with or without wheezing) usually indicates asthma. However, there are disorders in children that can be misdiagnosed as asthma, including congenital (present at birth) heart disease, bronchopulmonary dysplasia (a chronic lung disease), primary immunodeficiency (disease that triggers autoimmune disease or unusual susceptibility to infection) and upper airway disease.

A proper diagnosis is important, because it gives physicians a roadmap for treating the patient most effectively.

About asthma and other lung diseases

Asthma is a chronic (ongoing) inflammation of the body’s bronchial (airway) tissues that afflicts millions of people in the United States. People with asthma experience symptoms such as:

  • Wheezing
  • Shortness of breath(dyspnea)
  • Cough (often at night)
  • Exercise-induced wheezing and dyspnea
  • Variable airflow obstruction

Researchers have also gained increasing insight into the physiological makeup of asthma. In the 1950s and 1960s, the presence of bronchoconstriction (narrowing of the airway) became an acknowledged feature of asthma. In the next few decades, researchers began to note the important role that airway hyperresponsiveness (AHR) (an exaggerated airway response) and inflammation played in asthma.

Despite everything the healthcare community knows about asthma, to date there remains no single physiologic test that conclusively determines whether or not a person has the condition. Instead, healthcare providers rely on reports of symptoms and various tests before concluding that asthma is the likely source of an individual’s breathing problems. In many cases, a physician cannot make an asthma diagnosis until other diseases have been ruled out.

Several other lung diseases may cause similar symptoms or are otherwise related to asthma. These include:

  • Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis

  • Cardiac asthma

  • Bronchitis (chronic and acute)

  • Bronchiectasis

  • Cystic fibrosis

  • Vocal cord dysfunction

  • Congenital heart disease

  • Bronchopulmonary dysplasia

  • Primary immunodeficiency 

  • Upper airway disease

Sometimes, a healthcare provider will have relatively little trouble accurately diagnosing asthma or another lung disease. For example, most of the time, (COPD) can be ruled out in young patients. Conversely, COPD is a likely diagnosis in a person middle-aged or older who has a long history of smoking and the typical symptoms associated with the disorder.

However, an accurate diagnosis can be difficult for patients who have symptoms common to both COPD and asthma, but do not have symptoms unique to one condition or the other. This is true for other lung disorders as well. Wheezing, chest tightness and shortness of breath are symptoms not only of asthma, but of acute viral infections as well.

Asthma is a more likely diagnosis when the following factors are present:

  • Typical symptoms such as cough, wheezing and breathing problems

  • Family history of asthma, allergic rhinitis, atopic dermatitis and/or eczema

  • Patient history of exposure to triggers such as pet dander, cockroaches and tobacco smoke.

A key feature of asthma is airway blockage and inflammation that can be reversed through treatment. Tests that can be used to help confirm the presence of asthma include pulmonary function tests, with spirometry (lung measurement) and assessment of airway responsiveness using methacholine or histamine (bronchoprovocation test). Physicians may also perform other tests, including imaging tests (e.g., chest x-ray) and blood tests, to rule out other conditions.

Once diagnosed, asthma is a highly treatable condition. Various asthma medications, including bronchodilators, corticosteroids and leukotriene modifiers, are available to help prevent asthma attacks, or treat them once they have begun. Asthmatics can also modify their environment and day-to-day behavior in ways that reduce the likelihood of an asthma attack.

About COPD

Chronic obstructive pulmonary disease (COPD) shares one major feature with asthma: airflow limitation. However, whereas asthma is almost always reversible, COPD – which is a combination of chronic bronchitis and emphysema – is usually difficult to treat. COPD causes permanent damage to the air sacs (alveoli) and smaller bronchial tubes of the lungs. It tends to become progressively worse over time.

Chronic obstructive pulmonary disease symptoms include:

  • Shortness of breath (dyspnea)
  • Cough
  • Sputum (material expelled in coughing)
  • Airflow restrictions that are difficult to treat
  • Wheezing
  • Decreased tolerance for exercise

A physician may suspect COPD if the patient is middle-aged or older and has a history of smoking. Other risk factors for the condition include exposure to secondhand smoke, occupational exposure to certain industrial pollutants, having a personal history of childhood respiratory infections and having a family member with COPD.

A pulmonary function test is the best way to confirm this diagnosis. Spirometry can detect reduced airflow during a forceful exhalation. A chest x-ray can reveal hyperinflation (an over-expanded lung) and a CAT scan (computed axial tomography) of the chest can reveal emphysema. Blood tests may also be used to help diagnose the condition.  

Chronic obstructive pulmonary disease treatment requires that the patient stop smoking. Inhalers, antibiotics, oxygen and surgery may all be recommended for those with this difficult-to-treat disease.

About cardiac asthma

Not actually asthma, cardiac asthma is a condition where the heart is too weak to properly pump blood, resulting in fluid buildup in the lungs. Cardiac asthma is one of the signs of heart failure.

Cardiac asthma symptoms include:

  • Wheezing
  • Coughing
  • Shortness of breath
  • Swelling (edema) of the legs
  • Swollen neck veins
  • Abdominal discomfort such as swelling, pain or nausea
  • Mental confusion
  • Galloping heartbeat (palpitations)
  • Kidney malfunction or failure (in the later stages of heart failure)

A chest x-ray may reveal this disorder’s trademark features, such as an enlarged heart or fluid in the lungs. An electrocardiogram (a record of the electrical activity of the heart) and an analysis of breath sounds also can help reveal cardiac asthma.

The symptoms of cardiac asthma will disappear once the patient’s heart failure has been successfully treated with diuretics, which reduce blood pressure and fluid in the lungs. In some cases, a patient may suffer from both cardiac asthma and asthma. Treatments for both conditions are required in such instances.

About bronchitis

Bronchitis is an inflammation in the lower airway of the respiratory system that can be allergic (caused by an allergic reaction) or nonallergic. Allergic bronchitis is also known as bronchial asthma or allergic asthma and shares the characteristics of asthmatic disease. Patients with allergic bronchitis need to avoid those allergens that trigger their symptoms.

Symptoms of nonallergic bronchitis can be similar to asthma and allergic bronchitis. There are two different types of non-allergic bronchitis:

  • Acute bronchitis. An infection of the bronchial tubes that appears suddenly and usually stems from bacteria or a virus. This disorder comes on suddenly and may feature:

    • Cough that produces mucus; if yellow–green in color, a bacterial infection is more likely

    • Shortness of breath worsened by exertion or mild activity

    • Wheezing

    • Fatigue

    • Fever, usually low

    • Chest discomfort

      Acute bronchitis is usually treated with antibiotics and/or anti-inflammatory medications, such as corticosteroids. Symptoms usually disappear within a few weeks of the first dosage of medication.

  • Chronic bronchitis. A long-term inflammation of the bronchial tubes, usually caused by years of smoking. Air pollution and industrial dusts and fumes can also cause this condition. It is often accompanied by persistent wheezing that is the result of infected mucus blocking the bronchial tubes, and inflamed bronchial walls.  Other symptoms include:

    • Cough that produces mucus; if yellow-green in color, a bacterial infection is more likely

    • Shortness of breath worsened by exertion or mild activity

    • Wheezing

    • Fatigue

    • Fever, usually low

    • Chest discomfort

    • Frequent respiratory infections (e.g., colds, flu-like illnesses)

    • Ankle, feet and leg swelling (edema)

    • Blue-tinged lips from low levels of oxygen (cyanosis)

Chronic bronchitis usually is accompanied by emphysema. When this is the case, the disease is known as chronic obstructive pulmonary disease (COPD). Antibiotics, bronchodilators and corticosteroids frequently are prescribed. Quitting smoking will likely reduce symptoms.

At present, no test is available that provides a definitive diagnosis of either acute or chronic bronchitis. Physicians will need to eliminate other possible conditions before diagnosing acute bronchitis using pulmonary function tests, medical history, reported symptoms, mucus analysis and other techniques.

About immotile cilia syndrome

Also known as primary cilia dyskinesia, immotile cilia syndrome is an inherited condition where tiny hair–like projections (cilia) fail to do their job of propelling mucus through the airways. As a result, mucus becomes lodged in the airways, blocking the respiratory tract. This allows dust, dirt and debris to accumulate and to potentially cause infection.

Immotile cilia syndrome symptoms include:

  • Coughing
  • Sputum (material expelled in coughing)
  • Wheezing
  • Breathing difficulties
  • Chronic headaches

This condition can be difficult to diagnose because it mimics other, more common conditions, including cystic fibrosis, another lung disease. A physician may suspect immotile cilia syndrome in individuals who cough excessively and who suffer recurring bouts of bronchitis, sinusitis or pneumonia. Biopsy is the only definitive method of detecting this condition.

Treatment for immotile cilia syndrome is very similar to that for cystic fibrosis. A technique called chest physiotherapy (which involves placing the patient in various positions and applying percussion to the chest wall) is used to help clear the airways. Medications are also prescribed that help thin mucus. In addition, antibiotics may be used to treat any respiratory tract infections. 

About foreign bodies

Sometimes an obstruction in the bronchial tubes or windpipe (trachea) can cause Wheezing and Coughing. The most common causes are foreign bodies (such as peanuts), bronchial tumors and the narrowing of the trachea after a procedure called a tracheostomy, a surgically created opening in the neck which allows direct access to the trachea.

Surgery to remove the obstruction may be necessary in some cases.

About bronchiectasis

Bronchiectasis is damage to the bronchial tubes caused by repeated infections.  It involves the production of very thick, green mucus that obstructs the bronchial tubes. This leads to abnormal stretching and enlarging of the respiratory passage. Symptoms may include:

  • Wheezing

  • Repeated bouts of bronchitis and pneumonia

  • A cough that is:
    • Persistent with large amounts of foul-smelling sputum
    • Accompanied by blood
    • Worsened by lying on one’s side

  • Shortness of breath worsened by exercise

  • Weight loss

  • Fatigue

  • Weakness

  • Clubbing of the fingers (abnormal amounts of tissue in the nail beds)

  • Paleness

  • Foul-smelling breath

  • Bluish skin discoloration (cyanosis)

The disease is often misdiagnosed as asthma or pneumonia. It often develops in childhood, but symptoms may not appear until much later in life. The condition can result from a birth defect (e.g., cystic fibrosis) or develop after birth due to injury, or disease (e.g., tuberculosis, pneumonia, influenza).

A standard chest x-ray often will reveal the condition. Sometimes, high–resolution computed axial tomography (CAT scan) is necessary to confirm the diagnosis and determine the extent of the disease. A sputum culture and other tests may also be used. 

Bronchodilators, antibiotics and corticosteroids may be used to treat flare-ups. Physical therapy can also benefit the patient by teaching them techniques to help clear the mucus. In severe cases, a lung transplant may be considered.

About cystic fibrosis

Cystic fibrosis is a hereditary disease that causes glands to produce abnormal secretions that block the airways, leading to significant breathing problems. A form of intestinal obstruction called meconium ileus afflicts a minority of newborns diagnosed with cystic fibrosis. For others, poor weight gain is likely to be the first symptom of cystic fibrosis.

Other symptoms may include:

  • Frequent, bulky, foul-smelling stools
  • Protruding abdomen
  • Slow growth
  • Coughing
  • Wheezing
  • Shortness of breath
  • Recurrent respiratory infections (e.g., pneumonia, sinusitis)
  • Gagging and vomiting
  • Disturbed sleep
  • Excessive appetite
  • Diarrhea
  • Greasy stools
  • Fatigue
  • Loss of smell associated with nasal polyps
  • Salty tasting skin

Several tests are used to diagnose this condition, including digestive enzyme trypsin analysis (high levels of this enzyme indicate the presence of cystic fibrosis), quantitative pilocarpine iontophoresis sweat test (measures the amount of salt in sweat) and stool analysis.

Treatment for lung problems associated with the disease includes routine vaccinations and influenza shots (viral infections increase lung damage). Patients may also benefit from regular sessions with a respiratory therapist who can teach them techniques to help clear mucus. Bronchodilators, antibiotics and other drugs may also be prescribed.

About vocal cord dysfunction

Vocal cord dysfunction occurs when the vocal cords become stuck in the closed position. Though not technically a lung disease, it frequently is misdiagnosed as asthma because it comes on suddenly and causes acute breathing difficulties and wheezing.

The major symptom is a shrill sound during breathing that resembles the sound a child makes during a case of croup (childhood viral disease). Other symptoms include:

  • Breathing problems
  • Difficulty speaking
  • Wheezing during inhalation

Because this is frequently misdiagnosed as asthma, it may take several examinations before the true nature of the problem becomes clear. Usually, an ear, nose and throat specialist can make the diagnosis via careful examination of the vocal cords.

Vocal cord dysfunction usually resolves itself. However, in rare emergency situations a tracheotomy (emergency air incision of the trachea) may be necessary to relieve obstruction. This disorder often is associated with panic attacks, and anti–anxiety drugs may help reduce symptoms.

About congenital heart disease

Congenital heart disease is a heart-related problem that is present since birth. Symptoms vary, depending on the type and severity of the heart defect. They may include:

  • Shortness of breath

  • Blue discoloration of skin (cyanosis)

  • Chest pain

  • Syncope (fainting)

  • Poor growth

Tests used to diagnose congenital heart disease include electrocardiogram or EKG (a recording of the heart’s electrical activity), echocardiogram (uses sound waves to visualize the structures and functions of the heart), chest x-ray and pulse oximetry.

Treatments vary based on the type of defect. The majority of types require medications and/or surgery to repair the defect. Drugs that may be prescribed to treat congenital heart disease include:

  • Digoxin (improves the function of the heart muscle)

  • Diuretics (allow the body to remove excess fluid that builds up in heart failure)

  • Prostaglandin E1 (improves blood flow)

  • ACE inhibitors (decrease the constriction of the arteries)

  • Inotrope drugs (strengthen the heart’s contractions)

About bronchopulmonary dysplasia

Sometimes called chronic lung disease (CLD), bronchopulmonary dysplasia is a disease in infants characterized by inflammation and scarring in the lungs. It develops most often following respiratory distress syndrome, but may also result from oxygen toxicity, mechanical lung trauma, infection or pneumonia. Symptoms of this disorder include:

  • Bluish skin coloration (cyanosis)
  • Shortness of breath
  • Rapid breathing

The condition is seen most often in premature babies, as well as older babies who suffered respiratory problems shortly after delivery. Tests that will help reveal this disorder include chest x-ray, pulse oximetry (measures oxygen concentration in blood), CAT scan of the chest and arterial blood gas analysis (measures oxygen and carbon dioxide in the blood).

Treatment usually includes additional ventilator support to deliver pressure to the lungs to keep lung tissue inflated, and to deliver supplemental oxygen. After the patient is weaned from the ventilator, oxygen may continue by a mask or nasal cannula for several weeks to months.

The patient may require antibiotics, bronchodilators, diuretics and anti-inflammatory medications. Fluid restriction and intravenous feeding may also be necessary. In addition, physical therapy can be used to clear the lungs of mucus and boost muscle performance.

About primary immunodeficiency

Primary immunodeficiency occurs when one or more essential parts of the immune system are missing or not working properly at birth because of a genetic defect. Symptoms may include:

  • Failure to thrive
  • Colds
  • Cough
  • Earaches
  • Fevers
  • Sinusitis
  • pneumonia
  • Rashes
  • Diarrhea

A medical history and blood tests will be used in diagnosing this disorder. Primary immunodeficiency disorders are treated primarily with antibiotics. Because they are inherited disorders, prevention is not possible.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding asthma and other lung diseases:

  1. Am I at risk for lung disease? If so, what conditions am I most at risk for?
  2. How can I prevent lung disease?
  3. What symptoms may indicate that I have a lung disease?
  4. What tests will be used to determine if I have a lung-related disease?
  5. Does this disease pose any danger to my overall health?
  6. How is my type of lung disease treated?
  7. Is my condition curable? Can the damage be reversed?
  8. Are my medications temporary or will I need to take them indefinitely?
  9. What may have caused me to develop a lung disease?
  10. When should I be concerned about my lung-related symptoms? What symptoms should I be immediately reporting to you?
  11. Can I still exercise at the gym?
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