Allernet > Newsletter > Any Questions?

Onset of Asthma at 60

I have just been diagnosed with asthma by my family doctor. She has told me that she feels I have only "transient asthma" however I still have a lot of questions. I am currently using albuterol inhaler, Pulmicort inhaler and cromolyn sodium inhaler, but she hopes to gradually eliminate the need for all of these. We both are concerned about the overuse of steroids in treating asthma and what will be discovered as a result of this in later years.

History - I was diagnosed with walking pneumonia in my left lung in January. No x-rays were taken, the pneumonia was detected by the doctor listening to my lungs. Following a two-week period of an antibiotic my lung was clear (as shown by x-ray), but I was still coughing and experiencing a whistling sound when I exhaled. I was then given albuterol inhaler followed in two weeks by the addition of a steroid inhaler. I requested some kind of test to prove I actually had asthma and had a pulmonary functions test in March which confirmed asthma. I am still not sure if this is conclusive although the doctor is convinced I do have asthma. As a child I had continual bronchitis. I have never smoked but up until I retired experienced lots of second-hand smoke.

On a weekend visit to my son in Toronto, I had to go to the emergency ward of the local hospital because I couldn't breathe without coughing and even the albuterol did not help. I was kept overnight and given 3 treatments with a mask + prednisone tablets to take for 7 days. After 2 days, I felt better and when I stopped taking it after the 7 days on the advice of my doctor, all the symptoms came back worse than ever.

My concern is that I am not getting better, in fact I seem to need the albuterol more often although I try to wait as the doctor wants me to restrict its use to a maximum of 4 times a day. I have a dry cough most of the time, but sometimes there is a yellow, sticky small ball of sputum which is the consistency of molasses.

Would inhaling steam help? It certainly did when I was a child with bronchitis.

Thanks for any comments/suggestions you might have.

Noreen D.

Thanks for asking about adult onset asthma beginning after a "chest infection".

It is not rare for asthma symptoms to occur during the retirement years following a viral pneumonia in a patient who had never before experienced any asthma-like symptoms. Symptoms may include wheezing, shortness of breath, tight chest sensation and difficulty getting air all the way into the lungs ["doc, I can't take a deep breath"].

From your symptoms as reported in your email to me, it seems as though you may still have an infection in the lung or above in the sinuses which is causing your excessive, thick mucus.

To be certain that asthma is present, I perform breathing tests on my patients with asthma symptoms before and after using nebulized albuterol or ipratropium. This allows me an opportunity to see exactly what effect the medicines have on each patient.

If you can not wait to use your rescue medicine [ albuterol ], then you are definitely out of control and your asthma medications need to be adjusted - again.

In situations such as yours, it is a good idea to rule out the aggravation of asthma symptoms due to acid reflux from the stomach into the esophagus and the possibility of sinus disease. Asthma does not get better until both the stomach and the sinuses are happy and clear.

Effective medications for adult onset post-infectious asthma include: albuterol [to open the lungs for several hours]; Serevent [which opens the lungs for a longer time than albuterol]; inhaled steroids [such as the Pulmicort that you are taking]; theophylline [to open the lungs and thin out the sticky mucus]; and consideration of the newer leukotriene inhibitors such as Accolate which either work almost magically within the first 7 days or do nothing at all. Still, even after taking these medicines in various combinations, some patients need to take oral steroids daily for months and sometimes for years.

It is most important to have an exact diagnosis so that your treatment can be tailored to your disease. An Allergy and Asthma Specialist can help by doing allergy testing and in most cases lung function testing as well. Your need for several rounds of oral steroids suggests that you need specialist attention.

I hope this info is useful to you.
Good luck.
Let me know how things are going.

Steve Kagen, M.D.
Allernet.com