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.

Here are a few examples:

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 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 often times the people with it will 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.

Where do you fall?

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 who knows and understands that while I am not a wheezer, my asthma is still very severe.

Is your asthma typical or atypical?

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Comments

View Comments (9)
  • TracyLee
    2 weeks ago

    I have typical adult onset mild asthma BUT maintenance meds are not enough for me to avoid symptoms. Except for hiking on clean air days, I wear a mask nearly full-time when I leave the house. (Pre-mask, I was using way too much albuterol).

    I have the common cough variant asthma BUT I don’t have the normal dry cough; I produce huge amounts of mucus during a flareup.

    I have typical allergic asthma with a wide variety of triggers BUT my reaction to irritants (for example, smoke and artificial fragrances) is always more severe than for allergy exposure.

    How do you see this?

  • FeelingShy
    4 weeks ago

    I am also a non-wheezer. Even my primary care dr says, “you’re not wheezing “

  • Leon Lebowitz, RRT moderator
    4 weeks ago

    Hi FeelingShy and thanks for this post. For you to be a ‘non-wheezer’ emphasizes just how important it is for you to be able to assess your own condition. I’m sure by working in concert with your physician, you’re able to manage your condition more successfully. Warm regards, Leon (site moderator)

  • rjmoon
    4 weeks ago

    Definitely atypical. I am the same – I rarely wheeze during an attack, but my chest gets tight, I feel short of breath and I cough uncontrollably. I also don’t have allergies, or at least any allergies that seem to contribute to my asthma. I was diagnosed 8 months ago, but thinking back, I’ve probably had it much longer than that.

  • Leon Lebowitz, RRT moderator
    4 weeks ago

    Hi rjmoon and thanks for your post(s). We appreciate your responding to this article and welcome this input from you. Wishing you well, Leon (site moderator)

  • rjmoon
    4 weeks ago

    I guess I should add, I’ve had allergy symptoms around dust for many years, and dust is a major asthma trigger for me, but when I recently had an allergy test it showed only seasonal allergies. Nothing indoor at all. Not sure if it was a false negative, or if I maybe have a sensitivity rather than a true allergy? Anyway, I digress

  • TracyLee
    2 weeks ago

    I’m sorry for the typos. I’m trying to get used to new glasses.

  • TracyLee
    2 weeks ago

    rjmoon, I’ve read the pollen is sticky, Easily attaching to clothing and shoes. Even with windows Closed and an air purifier running, pollen can Still be found in samples of house dust dust

  • Shellzoo
    4 weeks ago

    I rarely wheeze. I usually start coughing or my chest feels tight. Last week I had an unexpected exposure to dander where my chest got very tight but I never wheezed. I get frustrated when my lungs are listened too and nobody ever hears wheezes.

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