If your child has been coughing every night since returning to kindergarten, if you do not leave the house without tissues, or if your inhaler no longer provides familiar relief: You are not alone. The transition from summer to autumn brings patients to clinics convinced they have caught another virus. Sometimes they are right, but coughing, a runny nose, and breathing difficulties can also stem from allergies or asthma.
The nose and lungs are part of the same system
Allergic rhinitis develops when the immune system reacts to substances that are usually harmless, such as house dust mites, mold, pollen, or animal dander. Inflammation of the nasal mucosa manifests in watery nasal discharge, sneezing, and congestion, and sometimes itching and watery eyes.
Asthma is a chronic inflammatory disease of the lower respiratory tract, causing hypersensitivity and narrowing of the bronchi. It can manifest in coughing, wheezing, chest tightness, and shortness of breath. In allergic asthma, exposure to allergens can worsen symptoms. However, not all asthma is allergic: Viruses, exertion, smoke, and temperature changes can also trigger attacks.
Many asthma sufferers also suffer from allergic rhinitis. Both conditions can appear together and burden sleep and daily functioning. When the nose is blocked and one breathes through the mouth, air also does not undergo the filtration, warming, and humidification that occur in the nose. Therefore, it is important to investigate and treat symptoms in both parts of the respiratory system.
Why specifically in the transition season?
The return to kindergartens and schools and family gatherings increase exposure to respiratory viruses. In people with asthma, even a mild infection can trigger an exacerbation that lasts beyond the illness itself.
At the same time, humidity and dampness in the home can encourage mold and house dust mites. Added to this are pollen, haze, and temperature differences between morning, afternoon, and evening. The combination can worsen symptoms even in those who felt great in the summer.
Cold, allergy, or asthma?
A cold usually improves within a week to two weeks, and is sometimes accompanied by a sore throat and fever, although a cough can last longer. Prolonged watery nasal discharge, sneezing fits, and itchy eyes are more consistent with an allergy. A return of symptoms in the same season or following a specific exposure also warrants investigation. The appearance of nasal discharge alone is not sufficient for a diagnosis.
In children, a cough that wakes them from sleep, occurs during running or laughter, or recurs after respiratory illnesses may raise suspicion of asthma, especially alongside wheezing and shortness of breath. However, a cough alone does not prove asthma.
In adults, a dry cough or shortness of breath upon exertion is sometimes attributed to age and poor fitness. Asthma can also appear for the first time at an older age. In toddlers, diagnosis is more complex, because wheezing during viral illnesses is not necessarily ongoing asthma.
When symptoms recur or impair sleep and routine, seek evaluation. The investigation includes questioning and an examination, and where possible, lung function tests. If an allergy is suspected, skin tests or blood tests can be added. In young children, the pattern of symptoms and response to treatment are also used.
Why is a reliever inhaler not always enough?
Effective treatments exist for allergic rhinitis, including new-generation antihistamines, which are generally less sedating, and nasal steroid sprays. Proper and consistent use, according to instructions, is important to achieve an effect.
In asthma, inflammation must also be treated, not just bronchial narrowing. An inhaler containing only a bronchodilator can provide quick relief, but does not treat the inflammation. Guidelines recommend treatment including inhaled steroids for adults, adolescents, and school-age children with asthma, according to medical suitability. Some inhalers combine fast relief and anti-inflammatory treatment in the same device.
A need for a short-acting bronchodilator alone for symptom relief more than twice a week, except for preventive use before exertion, warrants checking disease control. It is also important to check inhalation technique and treatment adherence.
In severe asthma that is not controlled despite optimal treatment, biological drugs can be considered. For some patients with respiratory allergies, allergen immunotherapy is also suitable, under professional evaluation and supervision.
Preparation for winter starts now
A common mistake I encounter is stopping treatment because one feels good. The absence of symptoms does not guarantee that the disease has passed. Do not stop or alter treatment independently; ahead of winter, it is advisable to check that it is suitable and form an action plan for exacerbation.
It is also important to know when not to wait for an appointment: Significant shortness of breath at rest, difficulty speaking in sentences, cyanosis, abnormal drowsiness, or lack of improvement after prescribed relief treatment require urgent medical assistance. In a severe situation, call MDA 101. In a child, severe respiratory effort or difficulty drinking requires urgent evaluation even without a prior asthma diagnosis.
Practical steps for preparation:
- Get vaccinated against the flu according to recommendations.
- Treat dampness and mold, and reduce exposure to smoke.
- Wash bedding in hot water according to manufacturer instructions.
- Ventilate when air quality is good; in haze, reduce exposure and close windows.
The author is a senior physician in the Allergy and Clinical Immunology Unit at Meir Medical Center, Kfar Saba.