basal cell carcinoma

Atypical Asthma

While the majority of people with asthma have so-called “typical” asthma, about 5-10% experience atypical asthma. The usual symptoms do not occur in atypical asthma and the treatment is less effective. Atypical asthma is a new concept, and more research is needed to fully understand this condition.  Let’s review in this article what is known so far about atypical asthma and how it is different from typical asthma. 

Typical versus atypical asthma

  • Typical asthma. As the name implies, typical asthma manifests with typical symptoms of this condition : shortness of breath, wheezing, coughing and chest tightness. Doctors and other healthcare professionals specialized in lung diseases always look for these symptoms when a patient is suspected or confirmed with asthma. 

Typical or normal asthma is associated with mild or moderate inflammation of the airways, which are also hyperactive and become narrower when exposed to allergens such as dust mites, pet dander, or pollen. As a result,  the airflow is reduced and they get the symptoms. Typical asthma responds well to medication and the symptoms are under control.  

  • Atypical and severe asthma. Asthma experts from the Severe Asthma Research Program (SARP) identified a second form of asthma, which is the severe asthma. This form of  asthma is less responsive to standard asthma medications, and is associated with an increased risk of severe acute attacks and dying from asthma. 

Atypical asthma presents differently than normal asthma. In some cases, there is no wheezing and the chest is silent because the small airways are too narrow and do not allow much air to pass through. Those who experience non-wheezer/silent chest form of asthma may get wheezing once the medication is given and the airways relax. 

Some people may present with cough only or shortness of breath only. Unlike typical asthma associated with excess mucus, cough variant asthma is usually dry and non-productive. The cough variant asthma is triggered by indoor and outdoor allergens, just like normal asthma. This form of atypical asthma requires lung function tests like spirometry to confirm the diagnosis. 

 Others feel chest tightness or chest pain without any other symptoms. Some people may experience atypical asthma with rapid breathing (also known as hyperventilation syndrome). 

Some healthcare professionals consider non-allergic asthma as atypical asthma. About one-third of people with asthma do not have any allergies, and the major triggers of asthma attacks are intense emotions, stress, or changes in weather. 

Just like in typical asthma, the airways are inflamed and become hyperactive when exposed to triggers. Severe asthma is also associated with scarring of the lung tissue and remodeling which formed due to years of poorly managed symptoms. This damaged tissue causes air trapping, which makes a person feel as if is unable to fully exhale the air. The airflow is severely limited during an asthma attack and the medicine is not reversing the symptoms.

Atypical asthma tends to develop early in life, during childhood, and is often associated with allergies (which can also be severe), Severe asthma that develops in adults is usually linked with respiratory infections, hormonal imbalances, or environmental triggers.

Unusual and/or less known symptoms of asthma

Asthma may cause other symptoms that go beyond the well-known wheezing, coughing, shortness of breath, and chest tightness.

  • For example, insomnia and sleeping problems can occur with or without symptom aggravation at night. This is because the airway function decreases during sleep in all people, and even more in those with asthma. The subtype of asthma that occurs almost  exclusively at night is known as nacturan asthma. Indoor allergens such as dust mites, pet dander and pollen (often brought from outdoors on clothes and shows) seem to be responsible for sleeping problems and symptom aggravation. 
  • Many people with asthma experience significant fatigue. Fatigue correlates with sleeping problems and also with the extra effort needed to breathe and carry day to day activities. 
  • Skin itchiness and itchy throat can also be symptoms of asthma, especially when asthma is associated with allergies. In addition to itchy skin, some may experience sneezing, runny nose, skin rashes and congestion of the sinuses and airways. It is worth getting allergy testing to identify the triggers which then can be avoided. 
  • Anxiety and depression are more prevalent in those with asthma compared with the general population. Those who have both depression and asthma tend to have  more inflammation in the body and poorer outcomes. 

In medical textbooks, asthma causes cough, shortness of breath, wheezing,  and chest tightness. However, in real life people with asthma experience different signs and symptoms, as each person is unique. As scientists learn more about atypical asthma, more treatment options may be available in the future. It is also important to address coasting conditions like anxiety, depression, or sleeping problems to better manage asthma as well. 

Subscribe to SARP, which is the National Institutes of Health/National Heart, Lung and Blood Institute Network to get updates once more research becomes available. 

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