Question:
Is adult-onset asthma linked to cancer? A friend of mine who has had asthma
all of her life recently told me this. I've been diagnosed with asthma for
about 4 months now. Ever since I can remember I've been plagued with
allergies and at certain times of the year, I've developed an annoying
phlegmy cough. Spring and fall seem to be the worst times. This has been
going on for twenty years now. With a tendency toward lingering colds which
develop into bronchitis since my twenties, I've always gone to the doctor,
been treated with various antibiotics and sent on my way. Last spring I went
to work in my garden and after being there for about 40 minutes I began to
cough and wheeze violently. I dismissed it as a severe allergy, took some
allergy medicine and assumed I'd be fine except I did not stop wheezing. Two
days later I went to the doctor and after a complete physical, he declared me
asthmatic prescribing prednisone, albuterol and cefzil. I did get better but
every now and then I still wheeze. This worries me immensely as I've never
wheezed before. Could my friend be correct? Did my doctor "miss" something
on my x-rays or is this recurrent wheezing just a by- product of adult-onset
asthma? I am currently on Singulair. I'm not so sure this is the "cure" as I
go for days without wheezing and out of the blue, I have a wheeze-ful day.
Further I must say that years ago I was diagnosed as having sensitivity to
mold spores. This allergy is high in my area now and may contribute to my
symptoms, yet my entire summer has been racked with one asthmatic episode
after the other. I might also mention that I have severe sinusitis and
gastro-esophageal reflux which I have heard contributes to asthma. I am being
treated for GERD now with propulsid and it seems to be working. yet I've also
heard that propulsid can cause wheezing as a side effect. Also, ever since
taking Singulair, I wake up in the morning with the sensation that my lungs
are over-inflated, as though I cannot exhale properly. Do any of you have
any ideas, comments or suggestions?
Answer:
I'm not aware of a link between adult onset asthma and lung cancer.
Lung cancer commonly occurs in patients exposed to carcinogenic
lung irritants, like cigarette smoke, asbestos, coal mine dust, etc;
and they generally end up with COPD, not asthma. However I wouldn't
rule out the possibility that those who got adult onset asthma as a
result of a chemical exposure (RADS) might in some cases be more likely
to develop lung cancer, depending on what the chemical was that
caused the asthma. Highly unlikely in your case.
Asthma is diagnosed using lung function tests and a spirometer.
Lung function is measured before and after administering a
bronchodilator inhaler, a 15% improvement tends to indicate asthma,
since asthma is a reversible disease (COPD isn't)
It sounds like you would benefit from a referral to a specialist;
usually an allergist or pulmonologist. At the least you probably
need more agressive treatment for asthma using the latest asthma
guidelines (Expert Panel Report 2). Sounds like you need to have
a steroid inhaler prescribed; like Flovent, Pulmicort, Vanceril.
An allergist referral would be suitable since its important to
find out what your allergies are to take steps to avoid them.
Often allergists also make good asthma doctors.
Its also advisable to use a peak flow meter to monitor lung function
along with an Action Plan to adjust meds to stay in the Green Zone.
GERD and Sinusitis can exacerbate asthma.
For GERD be sure to elevate head of bed 6" with wood blocks and
no meals within 3 hr. of bedtime.
Sinusitis needs to be aggressively treated; may require referral to
an ENT; a saline wash is a good hygenic measure.
Singulair is a good drug with minimum side effects for most, but
is not usually intended as primary control for moderate to severe
asthma. The primary control drug is steroids; oral steroids is a
sledgehammer approach, but needed for serious exacerbations. Many
asthmatics keep their asthma under control with steroid inhalers,
which results in typically a 30 times smaller dose than oral steroids.
A good book on all this is The Asthma Sourcebook, Francis Adams, MD
