That cough sure is persistent. Is it just a nasty cold, or something to be more concerned about? A chronic cough is the fifth most common reason people head to the doctor. But the real, underlying problem can sometimes be surprising: It could be asthma. Most people recognize asthma as a respiratory condition characterized by episodes of shortness of breath and wheezing. This chronic disorder affects nearly 20 million Americans, primarily children. Some asthma sufferers, however, don't have trouble breathing at all. For people who have cough-variant asthma, the primary symptom is a dry cough that lasts several days. During a typical asthma attack, the body's large airway, the bronchi, react to allergens and environmental irritants with contracting spasms. Inflammation and mucus narrow the airways even further, leading to difficulty breathing. In patients with cough-variant asthma, however, cough receptors in the lungs react to allergens. The airways may still constrict slightly, but not enough to hamper breathing because the expulsive force of the cough keeps them clear. This type of asthma is tough to diagnose. Unlike other asthmatics, cough variant sufferers may not have noticeably constricted airways or a wheezing aspect to their breathing. Patients themselves may inadvertently make diagnosis tougher by taking over-the-counter medicines for what they believe to be a cold or respiratory infection. This reduces symptoms enough that diagnosis becomes difficult. To confirm that a patient has cough-variant asthma, a doctor must conduct a simple test called broncho-provocation. During this procedure, a patient uses an inhaler to breath in a minute amount of allergens. For someone who does have cough-variant asthma, these tiny allergens are enough to provoke an immune response and start a bout of coughing. If there's no reaction, then that chronic cough may not be asthma and could require further evaluation. Treatment for cough-variant asthma is similar to that of other forms of asthma. The same medications are used and a patient must manage his environment doggedly to avoid symptom-triggering allergens. The only key difference is how a CVA-sufferer monitors asthma symptoms to prevent an attack. Peak flow monitors, which measure how easily air moves into and out of the lungs, aren't as effective for cough-variant asthma sufferers as they are for other asthmatics. Sufferers of cough-variant asthma may have peak flow levels within the normal range even if they are experiencing symptoms. Because symptoms tend to be worse in the morning, cough varient-sufferers who do choose to use a peak flow monitor will have the most luck then. These patients should pay particular attention to their coughing, because even a cough here and there may indicate a worsening of symptoms. It's also important to keep a record of the circumstances surrounding each attack. This will help people with CVA get a better handle on their symptom-inducing triggers. There is no cure for cough-variant asthma. But with treatment, symptoms may lessen or disappear entirely. If you think you may have cough variant asthmsa please see your doctor.