Asked by Chuck, Columbus, Ohio
I am in 55 and just started having difficulty breathing on occasion. I am a usually healthy, slightly overweight, never smoker. Could I have developed asthma at this age?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
You need to be seen by an internist or family medicine physician who will assess you and may send you to a pulmonary specialist or cardiologist. It is very reasonable to go to an emergency room if you are having an attack of difficulty breathing.
While asthma usually starts in childhood, it can begin at any age. It can be due to allergy to specific things such as smoke, dust or even roach droppings in an older home or apartment.
Some people get asthma with exercise and some have what is known as reactive airway disease, in which dust or even cold air causes constriction of the bronchial tubes from the lungs and wheezing.
The episodic nature is an important part of asthma at any age. The classic signs of asthma are intermittent shortness of breath, cough, chest tightness and wheezing. These are nonspecific and can be symptoms of a number of diseases. They can be symptoms of diseases causing partial obstruction of the respiratory outflow such as viral or bacterial bronchitis.
Non-respiratory conditions such as congestive heart failure, gastroesophageal reflux can mimic or even coexist with asthma. A rare person with COPD is a nonsmoker. A younger person with asthma symptoms might also merit evaluation for some form of cystic fibrosis.
Some less common, but still seen causes of asthma-like symptoms include a reaction to the angiotensin-converting enzyme inhibitors used to treat blood pressure. These widely used drugs such as captopril, lisinopril and enalapril are well-known causes of a cough.
Viral and bacterial infections of the bronchial tree including pertussis can also cause asthma-like symptoms. A person with asthma-like symptoms will be given several breathing tests to firm up the diagnosis. Spirometry will look at how quickly one can exhale air and how deeply one can inhale.
Certain spirometry patterns are diagnostic of asthma especially if breathing tests improve or return to normal with inhaled bronchodilator therapy. When presenting with shortness of breath or wheezing, people with a history of tobacco smoking must always be evaluated for chronic obstructive pulmonary disease.
Mild to moderate asthma is treated first by removal of anything that might trigger an attack. An inhaler with a beta-2 agonists taken as needed is then used.
Some patients will need a spacer in order to use an inhaler. More severe asthma is often treated with oral or inhaled steroids, and drugs such as theophylline and cromoglycates. Higher-dose steroids with long-acting beta agonists inhalers are used for exacerbations of more severe disease.
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