Most people know about asthma, and the coughing, wheezing and shortness of breath that come with it. But in recent years, a new form of the condition has taken the spotlight, known as cough-variant asthma.
Kelly Hamilton, 50, from Monroeville, Pa., was recently diagnosed with CVA. Suffering from a nagging cough, laryngitis, headache and allergy symptoms, she consulted her primary care doctor, who prescribed an antibiotic, a nasal spray and a rescue inhaler.
While they all eased her coughing, they didn’t get rid of it completely. To investigate further, her primary care doctor prescribed a reflux medication, which is often given to help rule out traditional asthma. She was also referred to a pulmonologist.
Hamilton says the reflux medication helped, and through this discovery and some teamwork, she was diagnosed with CVA. She says if it weren’t for her doctors’ persistence, her breathing wouldn’t be where it is today.
“My doctors were very informative and supportive as they guided me through this process,” Hamilton says.
A complicated conclusion
The main difference between traditional asthma and CVA is a chronic, nonproductive cough—one that doesn’t produce mucus from the respiratory tract. CVA is sometimes called chronic cough because it lasts longer than six to eight weeks.
Because it doesn’t leave behind any physical trail, CVA can be difficult to diagnose. It’s often misdiagnosed as bronchitis, sinusitis, post-nasal drip, or upper respiratory infection.
“The diagnosis is very complex,” says Dr. Mark Dykewicz, chief of allergy and immunology at St. Louis University. “A chronic cough can be caused by so many different things—acid reflux, blood pressure medications, pet allergies, sinusitis. It can be very frustrating for both the patient and the doctor.”
Though CVA is typically diagnosed in young children, previously undiagnosed adults ages 40 to 50 will complain of symptoms. Dykewicz says common triggers include cold air, exercise and exposure to mold.
“An initial step (in diagnosing) is discovering what triggers the cough,” he says.
A key factor in helping Hamilton control her symptoms was learning her triggers, which included the common ones, and also some ones she never considered—spicy foods, tomato sauces and stress.
“Learning what triggers my symptoms is an ongoing process,” Hamilton says.
Initial treatments often include a daily-inhaled steroid, plus a short-acting bronchodilator, which functions as a rescue inhaler when symptoms crop up. Treatment can take a few weeks to become affective.
Under control, on your terms
Dr. Mark Esterle is a pulmonologist with Louisville Pulmonary Clinic in Louisville, Ky. He treats severe cases of adult CVA, and says the disorder has recently gotten more widespread. After learning what triggers the symptoms, the next step is to work with a doctor to determine the best treatment plan, he says.
“We provide patients with a simple peak flow meter, which they can use three times a week to test their breathing,” Esterle says. “Based on their breathing level, they can increase or reduce their daily medications on their own.”
Hamilton was prescribed an inhaled steroid, and says her CVA is now under control. She manages her symptoms with the steroid twice per day, the reflux medicine, and the rescue inhaler as needed. She continues to visit both of her doctors every six months.
“My doctors were determined to find the cause of my coughing, and thankfully they did not give up,” she says.
