Monday, September 1, 2014
Asthma of Undetermined Origin
I am a 43 year old nonsmoking female. I was diagnosed with allergic asthma when I was 10 years old. I was fine as long as I stayed away from cats and did not play outside when it was cold. As I got older, my asthma became more pronounced, but only when I was around cats or in a house where cats had once lived. I was started on an albuterol inhaler when I was 27. When I was 37, we moved to a house that had been inhabited by 3 cats, and my family doc started me on Advair 500/50. Our insurance changed, and I had to change family doctors, and my new doctor lowered the Advair dose to 250/50 and I used my rescue inhaler as needed. I should note here that I have always, since birth, lived in homes with multiple dogs and have never had an allergic/asthmatic reaction to a dog. My asthma was under complete control.
Last month, I caught a chest cold which exacerbated my asthma terribly. Two weeks after the cold started, I wound up in the ER with extreme wheezing, coughing, shortness of breath, and very rattly chest, and my family doc gave me a prednisone burst, upped my Advair to 500/50, and started me on a nebulizer with Duoneb 3x daily and albuterol as needed. A chest x-ray came back negative. I visited an allergist and was tested, and the only thing that I came up as being highly allergic to was cats-so the allergist said that my asthma is apparently not allergy-based. (My IgE was also lab tested and came up normal.) I am fine as long as I use the Duoneb every 6-8 hours. If I go much longer, my chest tightens, my breathing becomes rattly, and I get short of breath. My peak flows are 350 in the morning before my meds and 400 in the afternoons. My peak flow before the Duoneb was 250.
No one can give me a satisfactory answer as to what is causing this extreme asthma, and I have been labeled as having asthma of undetermined origin by a pulmonolgist I visited yesterday. My question is, is this common? I thought all asthma had to be allergy-related. My other question is, am I going to be using a nebulizer the rest of my life, given the degree of my asthma symptoms?
There are many factors that influence asthma. Some are allergic and some are not.
You mention an allergy to cats. It is possible you are triggering/worsening your asthma living in a home previously inhabited by 3 cats. Cat dander is very difficult to eliminate from the home and traces can be found in the home for up to 15 years after the cats have been removed.
There are also non-allergic factors than can affect your asthma control. These include:
- Acid reflux
- Chronic sinus problems
- and others.
Colds are a very common trigger. Those with asthma will notice changes in their asthma control that can last for weeks afterward.
It is important to know that requiring the use of albuterol (nebulizer or handheld MDI) more than 2 times per week is a sign your asthma is not controlled. Other signs include more than 2 nighttime awakenings per month or breathing symptoms more than 2 times a week during the day. This is called the "rule of 2's". If your asthma is not controlled your may need to be placed on another controller medication to take with your current medication.
It is important to discuss your concerns with your medical providers. Bring your peak flow readings to your appointment and let them know how often you are experiencing breathing problems and requiring rescue/quick relief meds (albuterol).
Cathy Benninger, RN, MS, APRN, C-AE
Clinical Assistant Professor
Director, OSU Asthma Center Educational Program
College of Medicine
The Ohio State University