What else could it be?
There are other conditions that have similar symptoms to asthma, or that are common in people who have asthma:
- Hayfever (allergic rhinitis) can make life a misery and cause sniffles and stuffy noses, especially in springtime. Treating your hayfever will help keep your asthma under control.
- Reflux (Gastro-oesophageal reflux disease or GORD) might not be an obvious link, but it’s a really common problem – about 75% of people with asthma have it.
- COPD (chronic obstructive pulmonary disease): Some people who have had severe asthma for many years, or who also have a long smoking history may be at risk of developing COPD.
- Wheezing and coughing in young children can be alarming for parents, but it’s not a sure sign of asthma.
- Allergy affects around 80% of people with asthma, so you’re not alone.
- Anaphylaxis is the most severe form of allergy, and can be life-threatening
- Eczema causes red, itchy patches of skin, and affects one in three people in Australia at some stage.
Asthma and hayfever are closely linked, and approximately 80% of people with asthma also suffer from hayfever. Research shows that treating hayfever can reduce asthma related emergency department visits and hospitalisations.
Hayfever is the common name for allergic rhinitis. It is an allergic reaction to allergens, or triggers, breathed in through the nose – this causes an immune response in the lining of the nose so the nasal passages to become swollen and inflamed. If you only have it in spring and summer then the problem is usually pollen from grasses, weeds and trees. If you have it all year, it’s more likely to be house dust mite, animal dander (tiny scales shed from animal skin or hair) or mould spores.
The main symptoms of hayfever are:
- blocked nose
- watery, runny nose
- itchy nose
- watery eyes
- bad breath
Hayfever can also cause headaches, swollen and itchy eyes, and can affect your sense of smell.
Top tips for people with hayfever
- If you have hayfever and asthma, treating your hayfever will help keep your asthma under control
- Find out what triggers your hayfever and try to avoid those allergens
- Corticosteroid nasal sprays are the most effective medicine for persistent hayfever, or moderate to severe hayfever that happens from time to time, especially if a blocked nose and mucus are the major problems. They need to be taken regularly to work properly.
- Antihistamine tablets or spray are the most common choice for people with mild or occasional hayfever, and help with a runny nose, sneezing, itching and eye symptoms, but aren’t so effective on a blocked nose.
- People with severe hayfever probably need to take nasal sprays long term, and might see a specialist. They may consider you suitable for immunotherapy, where you are gradually exposed to your allergen over a long time to get your immune system used to it.
Most people with asthma (about 75%) have symptoms of reflux, also known as gastro-oesophageal reflux disease (or GORD), but we’re not entirely sure why. Asthma may make reflux worse, and reflux may make asthma worse, so it’s important to get both treated properly. Reflux is where acid that’s supposed to be in your stomach moves up into the oesophagus (food pipe), where it causes irritation. The most common symptoms are:
- heartburn – a burning chest pain or discomfort after eating
- regurgitation – when stomach acid comes back up into the mouth causing an unpleasant sour taste
- difficulty swallowing.
- See your doctor: some people can just use over-the-counter medicines while others need something a little stronger. Your pharmacist can help with medicines that you can get without a prescription
- Eating smaller, more frequent meals can help, and don’t eat just before going to bed
- Avoid trigger foods – the common ones are alcohol, fatty foods, chocolate, caffeine and tomatoes
- Quitting smoking and losing weight can make a big difference
Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe a number of lung conditions that are long-term, gradually worsen, and cause shortness of breath by reducing the normal flow of air through the airways. The most common are emphysema, chronic bronchitis and chronic asthma. Each of these conditions can occur on its own, although many people have a combination of conditions.
In Australia, up to 1 in 5 people over 40 years old are believed to have COPD.
The main symptoms of COPD are shortness of breath, cough, and increased mucus production; wheezing and chest tightness are also common. These can be very similar to asthma, so it’s important to have breathing tests (spirometry) to check what’s happening in your lungs.
COPD cannot be cured but it can be managed using a range of treatments, including inhaled medicines. It’s important for people with COPD to quit smoking, eat a healthy diet and exercise.
Smoking is the main cause of COPD. Around half of all smokers will develop some form of airflow limitation, and 15-20% of smokers will develop severe lung problems. The most important thing you can do to help yourself if you have any lung condition is to stop smoking.
COPD can happen in people who have had long-term environmental exposure to things that can irritate your lungs, like certain chemicals, dust, or fumes in the workplace. Heavy or long-term exposure to second-hand cigarette smoke or other air pollutants may also contribute to COPD.
In a few people, COPD is caused by a genetic condition known as alpha-1 antitrypsin deficiency – this causes COPD even if they have never smoked or had long-term exposure to harmful irritants. They tend to develop emphysema-type lung problems between the ages of 20 and 50. This is quite a rare condition.
Emphysema is a condition where the elastic fibres in the breathing tubes and in the air sacs of the lungs are destroyed. The breathing tubes become floppy and narrow, and the air sacs become stretched. The narrow airways make it harder to breathe air out, which can lead to air getting trapped (or hyperinflation) in the lungs. The combination of having extra air in the lungs, and the extra effort needed to breathe results in a feeling of shortness of breath.
Chronic bronchitis is a constant swelling and irritation of the breathing tubes, resulting in increased mucus production (phlegm or sputum). This causes the breathing tubes to become narrower than usual, making it harder to breathe. Frequent infections can also occur. This is different from the short-term bronchitis that people may get which lasts a few days or weeks.
Chronic asthma is where the airway inflammation becomes permanent, and can cause continuing symptoms, rather than going back to normal after a flare-up. It happens if asthma is not well treated, or is very severe over a long time.
What’s the difference between asthma and COPD?
COPD gets worse over time, and symptoms don’t usually appear until over the age of 50. People with COPD are likely to have smoked for a long time, and the changes in the airways don’t respond as much to medication. Asthma may start at any age, and people are more likely to have a history of allergic conditions such as hayfever or eczema. They have flare-ups, but the airways go back to normal with the right medicine treatment. Some people have a mixture of both conditions.
For more information on COPD, visit the Lung Foundation Australia’s website.
Wheezing and coughing in young children
Wheezing in babies does not mean they have asthma. More than half of infants who wheeze will stop after about three years of age. This is because these babies have smaller airways, and so they are more likely to make a wheezing noise, especially when they have a cold or flu. This is called ‘viral induced wheeze’. These children also usually don’t have other allergic diseases and have negative results on allergy tests. By about 3 years of age, the airways have grown and widened, and the wheezing often stops.
Asthma is more likely to develop in children who continue to wheeze after the age of 3 and have allergies such as eczema, hayfever, runny nose with a cold or whose parents have allergies. It is usually diagnosed over time as the doctor monitors the symptoms and response to treatment. Specific lung function tests (like spirometry tests) are difficult to do in young children.
Bronchiolitis is a common condition in babies under six months old and is caused by a virus. It starts like a cold with a runny nose, fever and mild cough and as it progresses they can develop a wheeze and your baby’s breathing can become more rapid and shallow. Most cases of bronchiolitis are mild and get better without treatment, however in some young babies it can be severe, and occasionally they need hospitalisation.
Croup is also caused by a viral infection and affects the larynx (voice box) and trachea (windpipe). It most commonly occurs between the ages of 6 months and 3 years and generally starts like a common cold – with a slight fever, sore throat and runny nose, and then after a few days they may develop a “barking” cough, a hoarse voice and noisy breathing. These symptoms often start at night when the air is cooler. This can last for a couple of hours then stop, only to return again for the next few nights. In most children, the symptoms improve over a few days then disappear. Most children don’t need medicine, though some with more severe symptoms might have a course of oral steroids to reduce the swelling in the windpipe.
Up to half of Australians will be affected by a form of allergy at some stage in their life. Allergy occurs when a person’s immune system reacts negatively to a particular substance in their environment, most commonly house dust mites, pollens, pet hairs, moulds, foods and some medicines. The areas most commonly affected are the skin, the airways, the nose and/or the eyes.
These reactions are then referred to as:
- Hayfever (allergic rhinitis)in nose/eyes
- Eczema (hives and itchiness) in the skin
- Asthma in the lungs
The most severe form of allergic reaction is known as anaphylaxis.
When you breathe in an allergen, the lining of the air passages in the lungs become swollen and this makes breathing difficult. Therefore asthma symptoms can occur during an allergic reaction.
Food allergy occurs in around 1 in 20 children and 2 in 100 adults. Reactions can be mild to severe, and it’s important to get a proper diagnosis through your GP or specialist. Common foods that may create an allergic reaction include cow’s milk, soy protein, egg, nuts, wheat, citrus, seafood and certain food additives. Talk to your doctor before making changes to diet. Referral to an allergist may be necessary to confirm which foods may be creating a reaction. More specific information on food allergy is available here.
If you think you are suffering from an allergy, keep a symptom diary of what happens to you and when it occurs and then see your doctor for advice. A useful website is the Australian Society of Clinical Immunology and Allergy.
Anaphylaxis is the medical term used for the most severe form of allergic reaction. An anaphylactic reaction usually happens less than 20 minutes after being exposed to a trigger and can very quickly become life threatening so it should always be treated as a medical emergency.
People who are allergic to a food and have a history of eczema and/or asthma are at a higher risk of anaphylaxis. You can only be diagnosed with anaphylaxis after you have had a reaction.
Early signs of a general allergic reaction are symptoms such as tingling in the mouth, hives or welts (red raised bumps on the skin), swelling of the face, lips or eyes and vomiting or abdominal pain. Anaphylaxis is when these symptoms then progress into a severe allergic reaction, with difficult/noisy breathing, swelling of the tongue and throat, difficulty talking or a hoarse voice, pale skin, floppiness particularly in young children) and loss of consciousness or collapse.
Anaphylaxis can occur after a person is exposed to an allergen, or ‘trigger’. The allergen is something the person’s immune system treats as a foreign object and reacts against. 90% of allergic reactions are caused by foods such as peanuts, tree nuts, egg, milk, sesame, seafood and soy, but insect venom or medications can also be triggers.
Talk to your doctor and if necessary, see an allergy specialist to help identify your trigger/s so you can avoid them. Your doctor should help you develop an anaphylaxis action plan, explaining how to recognise an anaphylactic reaction, what to do, medications to use (such as an adrenaline injector) and when to call an ambulance. The doctor will also explain when to return for regular follow up visits. It is also important that people around you (e.g. at work, school etc) know about anaphylaxis and how to help if you have a reaction.
If someone has an anaphylactic reaction, they will need an urgent injection of adrenaline. This is most commonly given through an automatic injector, and anyone who is diagnosed with anaphylaxis should carry one of these injectors with them, or have it very close by. If have one of these, make sure you and your family, friends or work colleagues know how to use it in a medical emergency.
Anaphylaxis Australia has more information, including advice, fact sheets, and information for kids.
Eczema, also known as atopic dermatitis and atopic eczema, affects 1 in 3 Australians at some stage in their lives. It’s really common in babies and young children but tends to improve as they get older. It causes red, hot, dry, scaly and itchy skin often on the face, limbs and body, and especially the ‘creased’ areas of the body: behind the knees, the elbows, the folds of skin in the neck and wrist areas. If these patches of skin are scratched, weeping sores may develop which can easily become infected and may then require antibiotic treatment. The skin naturally goes through cycles where eczema may flare up and then subside.
Eczema is not contagious and can usually be controlled using various creams and moisturising lotions, and by avoiding irritants. Some people also need to use medicated creams at times. Eczema is aggravated by things like dry skin, scratching, heat, hot bath water, and skin irritants such as soap or perfumes.
The exact cause of eczema is not known. It frequently affects people with other allergic conditions like asthma or hayfever; and people with eczema tend to have a family history of allergies, so there is likely to be a genetic factor involved.
You’ll find more information about eczema from the Australian Society of Clinical Immunology and Allergy.