Atypical Asthma

Whether you are new to the asthma world or a seasoned veteran, you may have heard the phrase “atypical asthma” used here and there and maybe aren’t sure what exactly it means. Asthma becomes “atypical” when the main symptoms are not the usual ones that the majority of asthmatics experience. Typical asthma has symptoms such as wheezing, coughing, chest tightness, and shortness of breath while atypical asthma has sometimes only one or even none of these typical symptoms.

Atypical asthma types

Cough-variant asthma (CVA)

In this type of atypical asthma, a cough is the main or ONLY symptom that happens when your asthma is flaring up.  With typical asthma, the cough can sound congested (although not always) and produces mucus. However, with cough-variant asthma (CVA), the cough is dry and nonproductive.

CVA is triggered in a lot of the same ways as more traditional asthma, including both indoor and outdoor allergens.  Higher intensity exercise can also trigger CVA due to intense coughing. CVA tends to be a more mild form of asthma and can develop into classic asthma.  Diagnosing CVA can be tricky because the people with it may have completely normal pulmonary function tests (spirometry).  Often times doctors will have a suspected CVA patient do a methacholine challenge test to confirm or rule out the asthma diagnosis.  CVA is treated the same way as more traditional asthma with inhalers and management of triggers and/or allergies.

The non-wheezer/silent chest

A silent chest is what scares us respiratory therapists the most.  A silent chest means little to no air movement is happening in the lungs due to everything being super tight. The absence of wheezing means that the small airways are too narrow for much air to pass through.  Once the airways relax and open up after a bronchodilator and/or corticosteroids are given, the wheezing sound may be heard (but not always).

Non-allergic asthma

While the majority of asthmatics also have allergies that trigger flare-ups, an estimated 1/3 of asthmatics do not have any allergies at all.  There is some debate as to if non-allergic asthma is actually an atypical type of asthma but I am including it in this post because it is not in the majority of typical asthma sufferers. In people without allergies, their asthma is set off by other things such as environmental (both indoor and outdoor) triggers, changes in the weather, intense emotions, and stress to name a few.

Is your asthma atypical?

I personally fall into the atypical asthma category.  I am one of the few who literally never wheeze.  My main symptom when it comes to my asthma is chest tightness and shortness of breath.  For others like me, you can relate to how frustrating it can be to go to the doctor or emergency room when your asthma is flaring only to be told, “Well you aren’t wheezing...” I am very thankful that my current medical team knows and understands that while I am not a wheezer, my asthma is still very severe.

Is your asthma typical or atypical? Share in the comments below!

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