Coughing is approximately zero percent fun. So, if you’re dealing with a persistent cough (technically one that lasts for eight weeks or longer), you might blame it on allergies or a lingering cold, then cross your fingers and hope it vanishes ASAP. If you have cough-variant asthma, though, that sucker’s going to stick around until you get diagnosed and treated. Yup, it turns out there’s a form of asthma where your only symptom is a cough.
Asthma happens when the airways stretching from your nose and mouth to your lungs become inflamed in response to a trigger, according to the National Heart, Lung, and Blood Institute. The muscles around your airways can tighten up, too, and your airways might spew out more mucus than they should. All of this can result in asthma symptoms like chest pain or tightness, trouble breathing, wheezing (a whistling sound) when you breathe, and coughing. But if you have cough-variant asthma, a chronic cough is your only sign that something’s wrong with your airways.
Cough-variant asthma is kind of random and possibly not on your radar, so here’s an introduction to this health condition—and what to do if you think you have it.
1. Cough-variant asthma happens because your body is trying to expel some sort of bothersome substance in your respiratory system.
When you cough, your body is trying to get rid of irritants and secretions like mucus from your lungs, the Mayo Clinic explains. So, if you have cough-variant asthma, your body can overreact to certain substances and strain to eject them via intense coughing, Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, California, tells SELF. Like other forms of asthma, you might have flare-ups and calmer periods, so your cough may get better and worse over time.
2. Classic asthma and the cough-variant kind can have the same triggers.
Everyone’s asthma triggers are different, but there are a few that come up more than others. If you have cough-variant asthma, you may end up coughing every time you hang out with a friend's cat, breathe in pollen (so, all spring long—fun!), or otherwise come into contact with something that makes your respiratory system freak out, Ronald Purcell, M.D., an allergist and immunologist at the Cleveland Clinic, tells SELF. According to the Mayo Clinic, common asthma triggers include:
- Dust mites
- Mold spores
- Cold air
- Animal dander
- Intense emotions like stress
- Some drugs like aspirin
- Smoke and other air pollutants
- Respiratory infections like the common cold
If you start to pick up on certain triggers you have, make note of them. That can help you get a diagnosis more quickly, and it can also help you figure out what to avoid in order to prevent coughing attacks.
3. Cough-variant asthma involves a “dry” cough, which is one way to tell it from your garden variety respiratory infection.
When you have something like a cold or bronchitis, you’re generally hacking up a bunch of slimy gunk when you cough. But cough-variant asthma causes a dry, “unproductive” cough, the American College of Allergy, Asthma and Immunology. Basically, you shouldn’t be expelling a ton of mucus or anything else that looks like an alien life form.
4. Doctors aren’t sure why some people get cough-variant asthma instead of classic asthma.
Asthma is asthma in that it all comes down to your airways acting up, no matter which type of asthma you have. But experts don’t know why some people only have a cough while others get the more typical symptoms like trouble breathing, wheezing, chest pain, and chest tightness. “It may simply be that some people have a lower threshold for a cough, and that’s how the asthma presents itself,” Krzysztof M. Nowak, M.D., a pulmonologist with ENT and Allergy Associates, tells SELF.
5. It can be hard to get a proper diagnosis because so many things can cause a cough.
When you’re sick, it’s easy to assume your doctor will know what’s going on and do what they can to make it better. That journey may take some time if you have this health condition. “It can be very challenging to diagnose cough-variant asthma,” Dr. Nowak says. First, you have to realize something is off and go to your doctor, which can be hard if you’re thinking of your cough as a remnant from your last cold or something along those non-worrisome lines. Then, if you go to your primary care physician, they may think about other causes of chronic cough first, like acid reflux or even classic asthma.
When your doctor does begin to suspect you have cough-variant asthma, they may try you out on something called a methacholine challenge. Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways, per the Mayo Clinic. That can usually cause people with cough-variant asthma to have symptoms, Dr. Casciari says.
People with cough-variant asthma also tend to respond really well to standard asthma medications, Dr. Purcell says, which can actually be helpful for a diagnosis. If you have a persistent cough and your airways become less irritated when your doctor tests you on a medication, it’s clear that cough-variant asthma might be the culprit. What are those meds, you ask? Right this way, please…
6. Your doctor can address your cough-variant asthma with the same treatments they might use for classic asthma, all with the goal of helping your airways work better.
That usually means putting you on a regimen that includes a bronchodilator, which is a drug that can quickly open your swollen airways. (So, if during the diagnostic process your doctor sees your cough abate after trying out a bronchodilator, that’s a clear sign of cough-variant asthma.) Other medications include inhaled drugs like corticosteroids (which help reduce inflammation) and long-acting beta antagonists (which help to prevent future asthma attacks), the Mayo Clinic says.
Another thing to keep in mind: Most people with cough-variant asthma don’t get relief from over-the-counter cough medicine, because those don’t target the airway issues that cause asthma. If you have a persistent cough (especially in response to certain triggers) but no luck with drugstore meds, you could be dealing with cough-variant asthma and should see your doctor.
7. Cough-variant asthma can turn into classic asthma if you don’t get treatment.
Even if you feel like you can somehow live with a constant cough, you still need to take care of cough-variant asthma so it doesn’t evolve. A portion of people with untreated cough-variant asthma will go on to develop classic asthma, Dr. Purcell says. Also, letting your cough-variant asthma impact your airways sans treatment can increase your risk of airway remodeling, a permanent change in your airways that can make it harder to breathe all the time—not just during asthma flare, Dr. Purcell says.
Bottom line: If you feel like you’ve had your cough forever, get it checked out.
Given that cough-variant asthma might not be at the top of your doctor’s list of possible causes, make sure to note any patterns with your coughing, like if it’s always in response to a particular trigger, and ask if that could be what you’re dealing with. If it is, you and your doctor can create an asthma action plan, which is a written document that can help you keep your symptoms under control. Getting a proper diagnosis can help you realize just how nice life is when you’re not coughing all the time.