A 25-year-old female presents with shortness of breath. She reported that in high school, she, on occasion, had shortness of breath and would wheeze after running. She experiences the same symptoms when she visits her friend who has a cat. Her symptoms have progressively worsened over the past year and are now a constant occurrence. She also finds herself wheezing when waking from sleep approximately twice a week.
Asthma commonly presents in children, but may present in otherwise healthy middle-aged individuals. Symptoms may start as a non-productive cough, chest tightness, shortness of breath, or wheezing, either spontaneously or on exposure to trigger factors. When the cough is productive, it is associated with clear and sometimes stringy sputum. Frequently, the patient is a non-smoker and will often have an atopic history, such as childhood eczema. In people with nasal polyps, examination of the lung is usually normal.
Exercise-induced symptoms may occur in around 50% to 65% of people with asthma. The concept of the 'cough-variant asthma' syndrome was popularised in the mid-1980s and it has become an all-embracing label for the symptom of recurrent cough. This has resulted in overdiagnosis of asthma and inappropriate therapy. Cough-variant’ asthma is rare and its existence is now questioned.