Tentatively posting this because it’s perhaps controversial on an asthma forum - but it is also really important.
It’s often assumed that any breathing symptom is asthma - those who have asthma assume it’s that because they have asthma therefore it must be that; those who don’t have asthma assume they’ve developed asthma.
Chest tightness, coughing, shortness of breath and wheezing can all be asthma symptoms - but not every tightness, cough, shortness of breath or wheeze are related to asthma. Very often they are not and, when this is the case, the symptoms will not be relieved or cured with asthma medications, however many are thrown at it. Instead they need different kinds of treatments. The conditions themselves and their respective treatments are no less real, no less difficult, no less frustrating or no less important than asthma - but it’s so important to find the right cause and in turn the right treatment so that things can improve. After all, you wouldn’t have your leg put in a cast to solve a gallbladder problem.
It can be difficult to unpick the different conditions because the symptoms can be very similar to those experienced in asthma (hence why they are often called “asthma mimics”). This is made more difficult by the fact that sometimes they occur instead of asthma but sometimes they occur alongside it. In people with confirmed asthma, type and severity of asthma are also irrelevant - there will always be other possible reasons for breathing symptoms.
A personal example is breathing pattern disorder (BPD) which is also known as Dysfunctional Breathing (DB). This is incredibly common in anyone with a known respiratory condition (although it can equally occur in those without one and be mistaken for asthma). It might occur after a virus (such as flu, pneumonia or covid) or a period of uncontrolled asthma - or it might simply develop because someone has had niggly (or quite frankly rubbish) asthma for some while. Basically the body forgets to breathe properly or develops unhelpful ways of breathing which are then unhelpful themselves and cause tightness, shortness of breath, etc. It’s a mechanical issue so asthma medication will not fix it. It's also a very real condition. Very often we are made to feel it's "in our heads", particularly if someone also has anxiety (the conditions can exist together but they don't always) but it just isn't (as any respiratory physio will tell you) and it's also not something one has any say over - it just kind of happens.
I saw a respiratory physio way back who taught me to teach my body better breathing patterns. The exercises were really good and I still use them from time to time. Earlier this year I had covid. I was most concerned that I wouldn’t know what was asthma and what was covid in terms of symptoms - but was surprised and pleased that, when the covid breathing symptoms appeared, they were very very different to my (severe and frequent) asthma symptoms. It sounds odd but I knew they were not asthma because the tightness and shortness of breath feels different and I knew the shortness of breath would not respond to reliever medication. They did, however, respond brilliantly to breathing exercises - done when symptomatic for just a few minutes, the symptoms went away. Of course perseverance was the key as I had to keep doing them when symptomatic but they definitely helped. It might not be as obvious a distinction in everyone (particularly I suspect if someone has more controlled asthma and so isn't used to the symptoms of it flaring), but having different things to try is useful (eg if reliever doesn't help, try breathing exercises).
This page from the British Lung Foundation (BLF) has some really good info on breathing techniques:
I found the breathing rectangle to be very good when symptomatic but I'm sure everyone will have their own preferences - one exercise a physio recommended just annoyed me so I don't do that one! 😅
Of course, as mentioned above, people experience BPD for many reasons but it’s important to deal with the issue or consider the issue because it could be being mistaken for asthma (in which case it’s not going to get better because no amount of asthma drugs will fix it) or it could be happening alongside asthma (in which case it’s also not going to get better if the asthma itself is controlled and it’s the BPD that needs treating). The country needs many more respiratory physios than it has!
It's worth mentioning here that some doctors/nurses are very clued up about these sorts of conditions - and others are not. This can be difficult as they can, in my experience and in friends' experiences, be either dismissive (not helpful when one needs the right sort of treatment for something!) or sort of lump anything into a "not asthma" heap, without trying pinpoint something specific in order to find a way forward.
Anxiety is another huge consideration - again, symptoms can be physical, very similar to those in asthma (particularly chest tightness and shortness of breath) and often debilitating. But again, the symptoms will not be relieved or removed by any amount of asthma medications so it’s important to deal with the cause of the symptoms. Furthermore, taking the likes of asthma medications might actually exacerbate symptoms if they're caused by anxiety - the meds have side effects that can easily cause further similar symptoms which can make anxiety worse. As with other conditions, anxiety can occur alongside known asthma as well as instead of it.
Asthma UK has a good page on asthma and anxiety
and EmmaF91 has previously looked into some of the differences of various conditions in this post:
There are all sorts of other issues that can cause symptoms similar to asthma but the principle is the same:
If you have asthma, it is important to speak to a GP or nurse if you are concerned or things are not as they normally are for you. If you are taking your asthma meds as prescribed but they are not helping/you have persistent symptoms and your peak flow remains good for you (especially if it’s always similar and doesn’t change if it’s done approximately 15 mins after using your reliever inhaler), it’s a sign that asthma may not be causing your current symptoms and they may have a different cause.
Having said all that, I absolutely wouldn’t want anyone with asthma to dismiss symptoms when it could be related to their asthma (and anyone who doesn’t have asthma should be contacting a GP about breathing symptoms). For this reason it’s important to:
• know your own asthma including what is normal for you
• take your meds as prescribed
• monitor peak flow regularly
• follow your action plan (if you haven’t got one, you should have!)
• know when to seek help ( healthunlocked.com/asthmauk... )
Finally, further information on other conditions can be found here
and the Asthma UK nurses are brilliant and available Monday to Friday, 9am to 5pm, on 0300 2225800.