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people with atypical asthma symptoms with some having check marks and others are crossed out

Asthma Sometimes Presents With Atypical Symptoms

Some asthmatics do not present with typical asthma symptoms. This is something we realize in this community. But what do researchers have to say about this topic? Have they studied it? Do they take it seriously? Here’s what to know.

What are typical asthma symptoms?

Asthma was traditionally considered a homogeneous disease. By this definition, all asthmatics would present the same and with typical asthma symptoms.

Typical symptoms of asthma are:

  • Shortness of breath
  • Chest tightness
  • Wheezing
  • Coughing

These are the symptoms most doctors have been trained to look for in their asthmatics. These are the symptoms nurses and respiratory therapists are trained to look for in asthmatics. But, as researchers continue learning about our disease, they are learning that not all asthma is the same.

What are atypical asthma symptoms?

Today we know asthma is a heterogeneous disease. This means it may present in different ways from one person with asthma to the next. We are also beginning to understand that asthma may sometimes present with atypical symptoms.

Atypical asthma symptoms are:

  • Chest tightness only
  • Wheezes only
  • Coughing only
  • No wheeze
  • Other

In this community, we know that asthma can present with an atypical presentation. We know because many of us have asthma. We have written about our experiences. Examples include:

Members of this community have joined in. Some of you have talked about feeling you were the only one to experience something. Only to join this community and realize you are not alone. You have expressed frustration that some healthcare people refused to treat you as an asthmatic because you “did not wheeze” or “were only coughing.”

Dismissing your atypical presentation may result in an improper diagnosis. It may result in you not getting the proper treatment you deserve. And this does not bode well for ending asthma attacks or achieving good asthma control.

What do researchers think about atypical asthma symptoms?

One group we should be interested in is Shen and company.1 They wrote about atypical asthma way back in 1990. They wrote:

“Although the classic triad of symptoms associated with asthma is cough, shortness of breath, and wheeze occurring simultaneously, it is not unusual for one or more of these complaints to be absent. Moreover, asthma may present with other symptoms.” 2

They went on to list examples of an atypical asthma presentation. 2

  • Cough only
  • Shortness of breath only
  • Chest discomfort only (chest tightness or chest pain)
  • Cough with the production of phlegm
  • Hyperventilation syndrome (rapid breathing)

In 2013,  Shen and company revisited this topic. They noted 24 patients whose sole presentation was chest tightness. A year later, Richard S. Irwin discussed the work of Shen and company. He wrote. 2

“While the varied clinical presentations of asthma have been known for years, this information is not generally appreciated, perhaps because this work was published 30-40 years ago. With their recent study, Shen et al. have supported the validity of these earlier findings.” 2

Asthma subgroups

This and other research has lead to new asthma subgroups. For instance, there is one asthma subgroup called cough variant asthma (CVA). This includes asthmatics whose only symptom is a chronic cough. CVA has now become a viable asthma subgroup.

This research has also lead to a new subgroup we might call “silent asthma.” I put this in quotations mainly because it is not fully defined for the medical community yet. So, an official name has yet to be determined, at least as far as I’m aware. Still, this would include asthmatics whose only symptom is chest tightness.

So, here we have a couple more asthma subgroups to investigate. Or, perhaps we could simply lump all of them under the umbrella subgroup called “atypical asthma.”

What does this mean for the asthma community?

Let’s quote Irwin one more time.

“Because asthma, a very common disease, can present with variant as well as classic symptoms, it behooves clinicians to be aware of the variety of presentations to avoid misdiagnoses as revealed by Shen et al.” 2

This means that a growing number of doctors should be learning about the atypical presentation of asthma. Although, in healthcare, sometimes it takes a long time for word to get out. So, this may explain the frustration some of us with an atypical asthma presentation have experienced.

So, what about you? Do you have atypical asthma? Do you have an experience you’d like to share? Please let us know in the comments below.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Shen, et al., “A new phenotype of asthma: chest tightness as the sole presenting manifestation,” Annals of Asthma, Allergy, And Immunology, 2013, September, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015002/, accessed 11/5/19 Irwin, Richard S., Chest tightness variant asthma (CTVA): reconfirmed and not generally appreciated,” Journal of Thoracic Disease, 2014, May, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015002/, accessed 11/5/19

Comments

  • Becca
    5 days ago

    I have atypical asthma DX at age 45. My asthma presented mainly as pain with occasional shortness of breathe. Now at 72 the more typical symptoms have shorn up.

  • John Bottrell, RRT moderator author
    5 days ago

    Hi. Becca. Thanks for joining the conversation. It’s so interesting how asthma can present to differently from one person to another, and how symptoms can change over time as you note. Do you feel your asthma is pretty controlled? Just curious. John. asthma.net Site Moderator.

  • ckratina
    1 week ago

    I have atypical asthma as well. I rarely wheeze and majority of the time I have chest tightness and cough with phlegm production.

    I am an RT and I can tell you first-hand that the majority of medical professionals assume all asthma must have wheezes. I was completely frustrated with my medical team when my asthma became severe and uncontrollable. I was on steroids off and on for over a year. I could barely function in day to day activities. Finally with biologics my asthma has become under complete control.

    Atypical asthma does exist but it is very difficult for medical professionals to diagnose due to the atypical symptoms. Even when PFT’s, CT scans, and symptoms point to the diagnosis.

  • Leon Lebowitz, RRT moderator
    1 week ago

    Hi ckratina, and thanks for joining in this conversation. I remember you telling us quite some time ago, here on our asthma.net website, that you were having success using biologics. We appreciate you continuing to share your experiences here with the community. Warm regards, Leon (site moderator asthma.net)

  • RosieK
    1 week ago

    Yes, atypical asthma can result in rather unpleasant experiences in the Emergency Department.

    I have neutrophilic asthma, dont respond all that well to steroids and cough.
    Have been told a few times that I don’t have asthma! Fortunately, I have a goid and supportive medical team!

  • John Bottrell, RRT moderator author
    1 week ago

    Thanks for sharing your experience with neutrophilic asthma (https://asthma.net/living/subgroups-the-basics-of-neutrophilic/). It is a subgroup of asthma that many physicians may not have much experience with. Great to hear you have a great medical team. That certainly does help. John. Author/ Site Moderator.

  • Shellzoo
    2 weeks ago

    I have different symptoms at different times. Usually I don’t wheeze but sometimes I do. Sometimes I cough and other times only my chest feels tight. I suspect maybe, just maybe the reason I have different symptoms at different times is because I have allergic asthma and different triggers give me different symptoms. That is just my suspicion.

  • John Bottrell, RRT moderator author
    1 week ago

    That’s interesting you say that, because I have often thought the same thing. This is exactly the kind of thinking that lead to my article “3 types of asthma attacks. (https://asthma.net/living/3-types-of-asthma-attacks/). Although, as you note, it’s probably way more than that. All the best. John. Author/ Site Moderator.

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