Five years ago, I was a graduate student at the University of South Carolina studying public health and social work. I lived in graduate student housing, worked as a graduate assistant for the Department of Health and Environmental Control (DHEC), took part in a social work internship, and carried a full load of classes. I was quite busy, so I wasn’t very happy when I came down with a nasty cold that incapacitated me for a few days. I eventually got over the cold, but I was left with a very persistent barking cough that would not go away no matter what I did.
That cough really cramped my style. I remember trying not to breathe too deeply because when I did, I would be seized by a fit of coughing that was loud and embarrassing. The cough was somewhat productive, too. As a medical social work intern, I had to visit with clients in their homes. One of my clients and his wife were heavy smokers. My coughing got so bad that even my heavy smoking clients would tell me to see a doctor!
Finally, I broke down and visited a family doctor, who told me she thought I was suffering from sinusitis leftover from my cold. Although I have never had trouble with my sinuses, she prescribed antibiotics. I took the medication, but it didn’t seem to help very much. I continued to hack and cough as if I were a pack a day smoker. Since spring break was coming up, I drove home to Virginia and consulted an ear, nose, and throat specialist who also thought I was having sinus troubles. I submitted to a limited CAT scan of my sinuses. When they came back clear except for one little nasal polyp, the ear, nose, and throat doctor said that he suspected I had asthma, a disease that he was unqualified to treat. He advised me to see an allergist – that is, a doctor who diagnoses and treats immune system abnormalities.
I was a little surprised to hear that I could have asthma. Like a lot of people, I thought people who had asthma had it all their lives. I remembered the asthmatics I had known growing up. They always seemed to be pale and sickly, sitting out of gym classes because they feared having an attack that would send them to the emergency room. My asthma attacks have, so far, never been that dramatic. During my attacks, I’ve never had much trouble breathing, nor do I have much severe wheezing. I just have a severe cough that wouldn’t go away. I didn’t want to hear that I could have asthma, especially since as a student, I didn’t have a lot of time or money for visits to the doctor. I put the ear, nose, and throat specialist’s tentative diagnosis out of my mind, relieved that the cough was gradually going away and I was feeling better, even though it had taken several months.
Fast forward to February 2003. I had graduated from school and was newly married. My husband and I were living in a very slummy apartment in Fredericksburg, Virginia, complete with old, moldy carpets, an antiquated heating and air conditioning system with poor filtration, and smokers of various types of weeds living all around us. We also had a dog who did a lot of shedding. I got sick with another debilitating respiratory illness the day after Valentine’s Day and spent several days in bed. The nagging cough came back with a vengeance and it was much worse than it ever was in South Carolina. Once again, I waited for the cough to subside. It didn’t go away and was especially troublesome at night. I would lie down in bed and immediately my body would erupt in a spasm of violent productive coughing. Neither my husband nor I got much sleep as I recovered from my cold and tried to cope with my cough.
I finally consulted an allergist when I had a fit of coughing that was so bad that I got lightheaded and almost fainted. I called a local asthma and allergy specialist who gave me a thorough physical and tested me for reactions to a wide variety of allergens. The allergy test was particularly interesting. A nurse had me take off my shirt and lie down on a table. Then she pricked the skin on my back with a number of different substances that commonly cause allergic reactions in people. She waited to see how my skin reacted to the allergens. The test wasn’t painful, but it did take awhile. Much to my surprise, I was at least mildly allergic to every substance they tested me for except one. The one substance I didn’t have an allergic reaction to is perfume. Though I’ve always had pets, it turns out I’m mildly allergic to dogs, cats, horses, and rabbits. I’m especially allergic to molds, pollen, dust mites, and smoke.
After the allergy testing, the allergist asked me many questions about my lifestyle and my living conditions, taking special note when I said that I lived in an apartment with old carpeting. It soon became very clear to me why I was having so much trouble breathing. My old apartment was riddled with mold, dust, pet dander, and other peoples’ smoke. My doctor told me that many people who suffer from allergies also suffer from asthma. Until I got asthma myself, I had always thought of it as a lung disease. While asthma affects the lungs, it’s often caused by a hyperresponsive immune system... the same thing that causes people to break out in hives when they are exposed to something to which they are allergic.
I left the doctor’s office with five prescriptions for drugs, a prescription for a chest x-ray, and a large bill. It turns out that allergy testing is quite expensive. I was billed over $500 for the allergy tests alone. Luckily, I had good health insurance, so I ended up paying a fraction of that. Even with the insurance coverage, finding out that I have asthma was not cheap, considering the tests, chest x-ray, doctor’s fees, and drugs. My doctor prescribed about $200 (after insurance) worth of prescription drugs, including Ventolin, otherwise known as albuterol, which is a rescue inhaler, Nasacort, which are pricey steroidal nose drops, Singulair, which is a medication for the allergies and asthma, Pulmicort, which is a powdered steroid inhaler, and Allegra, which is a prescription drug for allergies. I was able to dispense with the Singulair after about a month because it wasn’t doing anything for me, but I kept taking the rest of the drugs for several months. I had to learn how to use the inhalers, which took some practice. And despite all of the drugs, I was still coughing, albeit less often.
I finally got relief from my asthma symptoms when my husband and I moved from our slummy apartment. Our new home had wood and linoleum floors and a better ventilation system, which did wonders for my lungs. I noticed an immediate improvement as the coughing gradually subsided. In fact, right now, I don’t take any medications for my asthma. I’ve had other respiratory illnesses, but I don’t get the nagging cough that I did when I lived in apartment buildings with old carpeting. I thought I would hate having wood floors, but I’m breathing so much better that I’ve really become a fan of the bare floor look, especially since now I can scatter pretty rugs around my house.
There are some other things I do to keep my cough variant asthma at bay. I buy shower curtains that are treated to resist mold and mildew and am careful to replace the curtains when they get moldy. I use a vacuum cleaner with a HEPA filter and I try to keep my home as dust free as possible. I have the air conditioning filters changed on a regular basis. I’ve also placed special covers over my pillows that help keep allergens from escaping and irritating my lungs. My husband and I have never been smokers and we don’t currently share walls with anyone who does smoke.
I’m sure there will come a day when I will have to go back to using prescription drugs to control my asthma and allergy symptoms. For now, I’m just glad to know what was causing all the racket and what to do the next time it starts. Before I experienced cough variant asthma, I never knew that a person could be an asthmatic and never suffer the terrifying symptoms of narrowed airways and wheezy breathing. If you have a nagging, persistant cough that seems to be aligned with allergies, you may want to consult with an allergist and find out if you have asthma. It took me so long to get the diagnosis that I’m inclined to believe that cough variant asthma affects a lot more people than we know.
