Coughing in asthma

A cough is usually associated with colds, flu or bronchitis.

When a cough keeps coming back, it could be asthma. Asthma symptoms occur when the airways in the lungs become swollen and inflamed due to allergens or irritants. The body responds by coughing to remove the irritant.

The first step in preventing an asthma cough is knowing what irritants trigger coughing. Everyone is different, and a trigger for one person may not be a trigger for another person. Coughing can be triggered after spending time outdoors and being exposed to allergens from trees and grasses. Coughing can also be triggered by indoor allergens from pets, mold or strong odors in the air. Even exercise, stress or changing weather conditions can trigger coughing from asthma. If coughing becomes a problem more than twice a week, contact a healthcare provider to determine a long-term treatment plan for better control over your asthma.

It’s common for people with asthma to cough while also making a wheezing sound while breathing. There is another type of asthma known as cough-variant asthma (CVA) involving a chronic dry, nonproductive cough without wheezing as the primary symptom.

You may have CVA if your cough continues for more than six to eight weeks. The cough can disrupt your sleep or increase during exercise. The triggers that may induce coughing in CVA are similar to irritants and allergens in classic asthma. It is common to get a chronic cough after an upper respiratory infection. Also, a chronic, nonproductive cough is a known side effect of certain medications for a small percentage of people with this type of asthma.

Medication that can trigger CVA include:

• Beta-blockers, which are used to treat high blood pressure, heart disease or glaucoma
• Angiotensin-converting enzyme (ACE) inhibitors, which are used to treat heart disease and high blood pressure
• Pain relievers, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)

Your healthcare provider can adjust medications to ensure the lowest dose is used, change your medication if necessary, and address respiratory issues.

Tests for asthma include physical exams, chest X-rays and spirometry (a common test to measure breathing during inhalation and exhalation to see how well the lungs are working). Even in CVA, these tests may all yield normal results. If these tests are normal and CVA is suspected, your provider may order a methacholine or histamine challenge test. The test measures bronchial hyperresponsiveness or how easily contractions are triggered in the small airways in the lungs. A positive methacholine test for asthma is defined as a 20% drop in lung function.

Another way your healthcare provider may diagnose CVA is with treatment using asthma medication. If there is an improvement in coughing, you may be diagnosed with this type of asthma.

CVA treatments are similar to those given for classic asthma, including inhaled glucocorticoids and inhaled bronchodilators. You should see improvement in symptoms within six to eight weeks as these medications help control the asthma and disable the cough.

In addition, you may be prescribed prednisone for one to two weeks to relieve chronic, disabling cough. This treatment usually yields excellent results. Afterward, your healthcare provider will likely stop prednisone treatment but continue treatment with inhaled glucocorticoids for maintenance therapy.

An asthma cough can be a challenge, but it is treatable. Talk to your healthcare provider to find out what your options are so that you can get relief.

Published February 2021.