DEAR DR. DONOHUE: My wife of 55 years died last year from the complications of an illness known as alpha-1 antitrypsin deficiency. In her late 40s, she would become unduly winded doing the polka. After many internist and a few pulmonary specialist visits, all of whom prescribed asthma medicines for her, she persisted with a chronic cough. She finally found a pulmonary specialist who tested her for alpha-1 antitrypsin. In one of your articles, you failed to mention testing for alpha-1 antitrypsin deficiency for an asthmatic who did not respond to treatment. I hope you would recommend the blood test for people with asthmalike symptoms who do not respond to usual medicines. — B.S.

ANSWER: An under-recognized pulmonary condition that often is mistaken for ordinary asthma or emphysema is the inherited illness alpha-1 antitrypsin deficiency. Lungs have their own cleanup crew. The crew scrubs the millions of air sacs (alveoli) in each lung on a daily basis. This crew is a bit over the top. Something has to tell it to quit, or it damages the air sacs by overzealous scrubbing. That something is alpha-1 antitrypsin. People without enough of it develop symptoms of emphysema or asthma because of air sac damage.

Estimates have it that 3 percent of people diagnosed with COPD — chronic obstructive pulmonary disease (emphysema, chronic bronchitis, asthma) — have the alpha-1 antitrypsin deficiency. That amounts to well over 100,000 people in the United States, and most of them are not correctly diagnosed.

People with the deficiency have to guard their lungs carefully. They must have the yearly flu vaccine, and they also should have the pneumonia vaccine. They have to take precautions against catching colds, and should promptly report any changes in their symptoms or breathing to their doctors.

Augmentation therapy — supplying the missing enzyme intravenously — is promoted by many lung specialists, but not all.

The diagnosis of alpha-1 antitrypsin is confirmed by blood tests, tests often not thought of. They should be.

DEAR DR. DONOHUE: For the past two months, I have had an extremely dry mouth and a sensitive tongue. I have to sip water all day long. My doctor can’t find out what’s causing it. An ear, nose and throat doctor prescribed pilocarpine, which didn’t help. Do you have any ideas? — Anon.

ANSWER: I can suggest one illness — Sjogren’s syndrome. It’s an attack on the salivary glands by the immune system. The result is a dry mouth. Often, dry eyes are part of the picture. Even if it’s not Sjogren’s, doing the things that Sjogren’s patients do will help you.

Constant sipping on water is wise. Carry a squeeze bottle with you, and don’t hesitate to use it. Chewing sugarless gum promotes saliva production. Artificial salivas, found in all drugstores, can be helpful. Oasis mouth spray or Numoisyn liquid lozenges provide relief. The Biotene company makes many products that you’ll find on drugstore shelves. One or more of them will help keep your mouth moist. Although pilocarpine didn’t work for you, another oral medicine, Evoxac, might. You won’t go wrong by contacting the Sjogren’s Syndrome Foundation at: 800-475-6473 or on the Internet at www.sjogrens.org. The foundation will explain the syndrome to you in detail and give you many hints on how to control dry mouth.

DEAR DR. DONOHUE: We have a son who smokes cigars, but I don’t think he inhales. He suffers from migraine headaches. Is there a connection? — F.S.

ANSWER: I thought this would be a question easily answered. And I thought the answer would be “yes.” I can’t find any mention of such a connection.

However, let me make an unsubstantiated association. One of the theories explaining migraines is the theory of a decrease in blood flow that spreads through the brain. Nicotine decreases blood flow. Even if the smoker doesn’t inhale, he absorbs nicotine into the blood.

Your son should be willing to try a period of no smoking to see if there’s a reduction in the frequency of his headaches.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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