Dear Dr Tay

If I get asthma as an adult, does it mean I will get the other allergies that go with it, like rhinitis and eczema? What are the triggers of adult asthma please (so I know how I can try to avoid them)? Just FYI: I have allergic rhinitis but it’s not so bad now compared to when I was in my 20s. I am now 36 and a vegetarian.

Dear C****, having asthma does not necessarily mean you will have the other allergic manifestations such as allergic rhinitis. However, studies do indicate that allergic rhinitis is very common in asthma – up to 80% of patients with asthma can have rhinitis as well.

There can be many potential asthma triggers but an individual’s response to these potential triggers may be different. For example, house dust mite may trigger symptoms in one person but not in another. Commonly identified triggers include the following:

1.Allergens such as house dust mite, moulds, animal fur, cockroaches, pollen

2.Workplace allergens (depending on workplace environment) such as latex, flour, enzymes, wood dust, chemicals

3.Irritants such as smoke (active and passive smoking), environmental pollution, cleaning products

4.Medications such as aspirin, nonsteroidal anti-inflammatory drugs (e.g. Ibuprofen)

5.Weather changes, cold temperature, humidity

6.Exercise

7.Strong emotions

8.Rarely food additives such as sulphites

Hello Dr Tay

My eczema (had it when I was a child) suddenly reappeared last year (I’m now 52 years old) and I recently find that when I get coughs, they won’t go away easily like before. Is the eczema a “notice” of something else to come? Does it mean I will get asthma?

Dear N****, there can be different types of eczema. One common type of eczema is the allergic form which is quite common in childhood. The eczema you are having now may or may be the same as what you had when you were a child. You may wish to consult a doctor or a dermatologist for further evaluation.

Allergic eczema, as with other allergic conditions like allergic rhinitis, can increase one’s risk of developing asthma. Persistent cough may be a symptom of asthma and I suggest that you consult a doctor to determine the cause of your persistent cough.

Hello doc!

I started work in a new office and despite best efforts at keeping the dust at bay, I find myself sneezing more often. The air conditioning seems colder here but the units do get cleaned (I was told). Yet I find dust every day on my desk. Can I asthma-proof the office? Your advice is much appreciated. Thanks much!

Dear s******, both allergic and non-allergic rhinitis (what is commonly called ‘sensitive nose’) can give rise to persistent sneezing and other nose symptoms such as mucus production. Dust at the workplace may act as an irritant or an allergic trigger, thereby causing your symptoms. Regular cleaning of air-conditioning filters and keeping the workplace clean are ways of minimising the dust build-up. If your symptoms remain uncontrolled, you should consider seeing a doctor (your GP, an allergist or an ENT doctor) to discuss about starting medications to control your symptoms.

Hi Dr Tay

I have allergic rhinitis since I was born (I’m now 29 years old) and sometimes if I am allergic to something I get asthma-like symptoms (doctors always tell me that and ask if I have asthma). Could I get full asthma as I get even older? Thank you.

Dear S*******, asthma can affect people of all ages. So yes, you can develop asthma even as an adult. You should seek medical evaluation if you have on/off asthma symptoms (such as shortness of breath, wheezing, cough or chest tightness). Specific lung function tests can be performed to confirm the diagnosis of asthma.

Hi Dr Tay,

I am having running nose, cough and short of breath since last August.  I suspect that I have asthma but all the doctors whom have seen me at Singhealth said that I don't have and prescribed nasal spray, running nose and cough medicine to me. Now, already going to be one year, all these symptoms stillnever go off. And around 2 weeks ago, one of the doctors referred me to see sinus specialist in this coming September. 

Can I know from you, do I have sinus or asthma?

Thank you. 

Dear S******, “sinus” problems such as allergic rhinitis and sinusitis can definitely give rise to cough and runny nose. It is only possible to confirm or exclude the diagnosis of asthma after specific lung function tests. You may wish to discuss these tests with your doctor if you have not had any lung function tests performed. 

Hello doctor

I have a slight allergy to animal dander (like got too many cats in one place) because of asthma, which doctor diagnosed a few years ago. Recently I think I have allergy to varnish (I was renovating the home) and I started to wheeze and needed my inhaler. I was quite surprised. Are there other types of not so common substances that can trigger asthma? Can I get myself tested? Thanks!

Dear d****, unfortunately there are many environmental exposures that can trigger asthma symptoms in susceptible individuals. These exposures may act as allergens or irritants. An allergen is a substance that triggers the immune system leading to an allergic reaction. An irritant is a substance that does not trigger the immune system but can irritate the body leading to inflammation. Common allergens include house dust mite, mould, animal fur, cockroach and pollen. Other allergens include enzymes, flour, latex, animal protein, certain chemicals and medications such as aspirin. Irritants include smoke, environmental pollution, cleaning products, and solvents. You should try to avoid substances that trigger your asthma symptoms at home and in the workplace. Skin prick tests and blood tests for some of the allergens are available but it is usually not practical to test for all possible allergens. 

Hi Dr Tay

Used to smoke but gave up cold turkey when my son was born last year. Recently notice shortness of breath (I used to be able to run 10 clicks with no problems) and a whistling sound when I breathe. Could I have developed asthma? I’m now 35 years old. Will I need an inhaler and will I need it for the rest of my life? Could the condition get better and/or go away? Thank you.

Dear j****, kudos to you for quitting smoking. Your symptoms of breathlessness and wheezing (the whistling sound) can be symptoms of asthma. Asthma can certainly develop in adulthood. I would suggest that you consult a doctor for your symptoms. Lung function tests can be performed to confirm the diagnosis of asthma and your doctor can then decide on whether you require inhalers. 

Dear Dr Tay

I have not been able to lose much of my pregnancy weight gain (about 8kg to go) – I’m still trying – but have noticed that my breathing isn’t very smooth. While I was pregnant I thought that was normal – with all that additional weight. But now, it should have gone back to pre-pregnancy days. Could I have developed asthma and not know it? Thank you!

Dear s*****, you should consult a doctor if you have persistent breathlessness. Although breathlessness can be a symptom of asthma, other diseases and conditions can also give rise to breathlessness. Your doctor will be able to advise on the necessary tests required.

Dear Dr Tay

Is adult-onset asthma more serious than childhood asthma? What are some of its symptoms that we should be aware of? Thank you. 

Dear d***, both adult-onset and childhood-onset asthma should be taken seriously as both can lead to severe asthma attacks. Symptoms of asthma (in adults and children) include breathlessness, chest tightness, wheezing and cough. 

Dear Dr,

I have been having asthma since young. I have a few questions regarding asthma. 

- Will my asthma be passed to my child?

- Will my asthma pose any problems when I am giving birth?

- I also have allergic rhinitis and eczema. Are these problems caused by my asthma? 

- Apart from allergic rhinitis and eczema, what other illnesses are common amongst asthma patients?

Thank you for your help.

Dear M*****, please see my replies to your questions below:

1.Your child may be at a higher risk of having asthma since there is a family history of asthma. However, many other factors such as environmental influences also contribute to the overall risk of developing asthma. Therefore not everyone with a family history of asthma will go on to develop asthma. 

2.A proportion of women (about a third) may experience worsening of asthma control during pregnancy. It is therefore important to ensure good asthma control by optimising asthma medications and continuing with asthma medications during pregnancy. There should not be any issues arising from asthma during delivery if your asthma control is good.

3.Asthma in itself does not lead to allergic rhinitis and eczema. These 3 conditions are common conditions driven by an underlying allergic process.

4.Asthma has been commonly associated with other conditions such as gastroesophageal reflux disease (heartburn), chronic rhinosinusitis, obesity, and obstructive sleep apnoea.

Hi

I had asthma when young but it went away.

Now at 56 I have difficulty and pump turbuhaler every day. I have 2 cats with short hair.  How can I be healthy and asthma free.  Can I flush whatever blocking my throat and lungs possible?

Dear V*****, unfortunately asthma can recur in adulthood. Adults, more often than not, do not “outgrow” asthma. Although asthma cannot be cured, it can be well controlled. If you are having difficulties controlling your asthma, try to identify any factors that may be triggering your symptoms e.g. smoking, allergens etc. Also ensure that your inhaler technique is correct. Other co-existing medical conditions such as allergic rhinitis and obesity can sometimes worsen asthma symptoms as well. You should also seek the advice of your doctor as your asthma preventers may have to be adjusted. It is also important for your doctor to exclude other conditions that may mimic the symptoms of asthma. 

Hi Dr Tay,

I am having running nose, cough and short of breath since last August. I suspect that I have asthma but all the doctors whom have seen me at SingHealth said that I don't have and prescribed nasal spray, running nose and cough medicine to me. Now, already going to be one year, all these symptoms still never go off. And around 2 weeks ago, one of the doctors referred me to see sinus specialist in this coming September.

Can I know from you, do I have sinus or asthma? Thank you.

Dear K*****, lung function tests can be performed to confirm or exclude asthma. You may wish to discuss these tests with your doctor. Conditions such as allergic or non-allergic rhinitis (sensitive nose), and chronic sinusitis with post nasal drip can certainly give rise to runny nose and cough.

Dear Dr,

I was diagnosed with asthma last year as I started having problems with my breathing when exercising such as when jogging and during gym workouts. I was prescribed ‘Montekulast’ and so far it has helped control my asthma. I have not done any exercises since then and I would like to build myself up again. Is there any advice on cardio and how can I prevent exercise induced asthma symptoms? Thanks v much.

Dear J******, Montelukast is an asthma preventer and it is effective in preventing exercise-induced asthma symptoms. You should consider exercising again, but build up your activity level gradually especially since you have not been exercising for some time. Doing warm up activities prior to exercise protects against exercise-induced symptoms and you may not need additional medicines apart from Montelukast. Short-acting beta agonists such as salbutamol inhalers taken about 5-20 minutes prior to exercise can also effectively protect against exercise-induced symptoms. Do note that if your asthma symptoms become more frequent or uncontrolled, you may need an escalation of your asthma preventer to include inhaled corticosteroids (ICS). 

Dear doctor,

Since the haze that hit us extra bad about 4-5 years ago, my allergic rhinitis seems to have worsened. I even had a sleep test done to make sure I don’t suffer from sleep apnoea. Late last year, I had eczema – something which went away when I was a teenager – because my skin was very dry and now I am wondering if I might suddenly develop asthma too! I am 58 years old. Thank you very much.

Dear E****, the presence of allergic conditions such as allergic rhinitis and eczema are risk factors for asthma. An individual can certainly develop asthma in adulthood even if he/she did not have a childhood history of asthma. Common symptoms of asthma include breathlessness, wheeze, chest tightness and cough.

Hi Doctor.

I have asthma at the age of 5 and on spray whenever I go for exercise. Nowadays, I go swimming twice a month and the condition has improved slightly. I am now 16 years old and still on spray when doing any sport exercise. Since last year, I have this problem of sweating profusely even when I am not doing any activities. At night, when I am sleeping, I also sweat a lot even with the fan on.

Doctor is my profused sweating caused by the side effect of the asthma spray affecting my sweat glands? My friend told me that I should go for a nerve check about my profused sweating. So I am now stuck with what I should do.

For your professional advice.

Thank you.

Dear C*********, I believe your asthma inhaler is either a preventer (containing inhaled corticosteroids) or a reliever (such as salbutamol). These asthma inhalers do not typically lead to profuse sweating in patients. Thyroid disorders can sometimes lead to increased sweating or heat intolerance. As a first step, you may wish to consult your GP about your sweating problem and he/she will be able to advise you on further investigations required.  

Hi Doctor,

I had childhood asthma and it was off for almost 40+ yrs (I am now 59 yrs old), recently I experienced lots of different allergies (swollen eye, mouth/nose sore, hives around eyelids, itchy eyelids, block nose, mucous kept flowing) and my asthma symptoms (breathless, chest tightness, itchy throat resulting in persistence coughing, …) came back. Every time when if I have persistence cough it helps once I puff salbutamol. Please advise me.

1.I am confused whether I am having allergy or asthma? Is there any difference between them?

2.When I puff salbutamol, can I give 2 puffs instead of 1 for severe coughing?

3.I have sensitive throat, at time when I puff, it will tickle my throat and I will keep coughing so I think the medication that I puff does not get into my throat/lung, so I gave myself another puff. Is it OK to have 2 puffs at one go or how long should I wait for another puff.

4.What is difference between salbutamol, Ventolin, and are there any side effects for prolonged use.

5.I have seen a respiratory specialist but I think I need help for asthma management? Please advise which hospital or clinic has this service?

Appreciate your reply.

Thank you

Dear K*******, please see my replies to you questions below.

1.Allergy is an immune response to a foreign substance whereas asthma is a chronic airway condition whereby the airways narrow excessively giving rise to symptoms such as wheezing, breathlessness, chest tightness and cough. Asthma, together with allergic rhinitis (sensitive nose) and eczema are common allergic conditions. Allergic response to environmental exposures such as house dust mite may trigger asthma in susceptible individuals.

2.You may administer 2 puffs of salbutamol at a time if you experience asthma symptoms. However please note that salbutamol is a reliever medication and should be used only as necessary. If your asthma symptoms are persistent and uncontrolled, a preventer inhaler is required and you should not be using salbutamol only.

3.You need to ensure that you inhaler technique is correct. Sometimes you may find that using a space chamber with your salbutamol inhaler helps. You may wish speak to your doctor or pharmacist about this. 

4.Ventolin is also known as salbutamol. It is a reliever medication used to temporarily dilate your airways. It is generally well-tolerated although excessive use may result in palpitations. The need to use salbutamol regularly is a sign of poorly controlled asthma. If you feel that you depend on your salbutamol very frequently you should see your doctor about optimising your asthma control. 

5.Most respiratory specialists are well-equipped to manage patients with asthma. Only a minority of patients with asthma have what is called “severe asthma” that is refractory to conventional treatment. Your respiratory specialist will be able to advise you on whether you require referral to a severe asthma service. 

Hi doc

My grandfather suddenly developed a series of coughing episodes a few months back, with stuffed nose at times. Nothing alarming he said. He’s rather healthy for his age – he is 79 – and hardly gets sick. He smokes a pipe and I am wondering if that can bring on asthma at such an old age? Thanks!

Dear J***, asthma can certainly develop in the elderly. However, given that your grandfather smokes, other smoking-related lung conditions (such as chronic obstructive pulmonary disease) need to be considered as well. If his cough is persistent or troublesome, he may wish to visit a doctor who can advise on further investigations.

Dear doctor

My mom had eczema flare-ups even up to age 72. I understand it’s genetically passed down and my much older siblings (2) have asthma and allergic rhinitis and eczema. I’m now 28 years old and don’t have any of those. Is there a possibility that I could get asthma (or even any of the other 2 – allergic rhinitis and eczema – but the 2 or 3 always go together I was told) when I get older? Thank you.

Dear Y*****, you are absolutely right that there is a genetic component to allergic diseases and asthma. Having one allergic condition e.g. allergic rhinitis increases the risk of developing asthma. However, development of asthma is influenced by environmental factors as well as genetic factors. Therefore not everyone with a family history of asthma will inevitably develop asthma.