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Asthma

Asthma

02/10/2009

Question:

Back in Sept. I got a ct scan on my lungs and a lung function test done because I also have pulmonary hypertension. All the test came back normal. The lung spectlist told me that my PFT was even better then his. But evey time I get a cold or flu I get this realy bad barking cough. Also when I go out for my walk in the winter time and breath alittle bit hard at all. About 5 minutes after I come inside I get this realy bad barking cough. I almost throw up due to the cough and it last maybe 30 minutes. But go for a walk in the summer time I don`t cough. What could be going on there?

Answer:

It is very possible you have a condition call cough variant asthma triggered by cold air and viral infections.  Patients with this condition have normal lung function but have airway hyperresponsiveness.  This can be measured by a methacholine challenge test.  Methacholine is an analogue of acetylcholine and can stimulate the parasympathetic nervous system leading to bronchoconstriction (narrowing of the airways).  The test begins with low doses and serially increases the dose up to a maximum dose of 10mg/ml; if the patient's lung function drops by 20% from baseline then this is considered a positive test consistent with airway hyperresponsiveness which is a central feature of asthma.  Once the diagnosis is made (or excluded) then appropriate treatment can be recommended.  There are many medications effective for cold induced asthma including cromolyn sodium (Intal), inhaled corticosteroids and leukotriene modifying agents.  However, as these conditions tend to be chronic (last a long time) it is important that your doctor diagnose or exclude this disorder so that the appropriate treatment is prescribed.  It is unclear from the information you provided as to whether pulmonary hypertension has any relationship to the barking cough.   

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Response by:

Jonathan   Bernstein, MD Jonathan Bernstein, MD
Associate Professor of Medicine
College of Medicine
University of Cincinnati