Every one knows asthma leads to wheezing, shortness of breath and choking but many lay persons are not aware that it can present with only a dry cough.  In fact, in the younger age groups when a dry hacking cough appears as the only symptom, asthma should be considered as the most likely diagnosis.  When asthma presents with isolated dry cough in older age groups, other causes have to be considered at least as equal contenders.  Some of these are chronic bronchitis, simple smokers’ cough, cancer and an effect from certain blood pressure lowering medications in the class called “ACE inhibitors”.  Some examples of these are lisinopril, captopril and enalapril; once this type of effect is suspected, simply removing drug is almost immediately effective.  Some heart diseases such as heart failure can also mimic the ‘cough variant’ of asthma in that instead of shortness of breath, the patient complains of only a dry cough.  Another important condition to consider is an occasional patient with “acid reflux disease” in which excessive amounts of stomach acid trickles down the length of the esophagus and into the airways while sleeping.


            In most patients a simple breathing test (“Pulmonary Function Testing” or simply “PFTs”) will help confirm asthma but in some even these tests may be normal.  Then, a diagnosis is established by some type of challenge testing of the airways were substances such as histamine and methacholine are inhaled and breathing tests performed before and after to show the characteristic changes. Another way would be a trial of asthma medications.  Of course, it is essential that at least a chest X-Ray is done to rule out a hidden lung cancer or telltale signs of heart failure.  When acid reflux is suspected, appropriate testing may include an “endoscopy” (examining the stomach and esophagus through a scope) as well as measurement of the function of the junction of stomach and esophagus for telltale evidence of reflux. Here the treatment is medications to reduce acid formation as well as antacids and avoidance of alcohol, nicotine and several foods that the patient may identify as causing the reflux symptoms and when sleeping, keeping the head end raised.


If you have any questions or comments, you may e-mail P.K. Raghuprasad, M.D. at pkrp12@gmail.com


Disclaimer: The facts presented in this article and the views expressed are solely those of the author(s) and do not necessarily reflect the views of the Board of Directors or other members of West Texas Physicians Alliance.