Diagnosis

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Wheezing, coughing, difficulty breathing, and chest tightness are all symptoms of asthma. If you have these symptoms, consider seeing your health care provider to be evaluated for asthma.1

The diagnosis of asthma is based on your medical history, a physical examination, and a lung function test called spirometry. An accurate diagnosis is an important first step for treating asthma. Recent studies have shown that up to 30% of asthma diagnoses are incorrect.2,3 One reason so many people are misdiagnosed is that there is no standard test for asthma.

After asthma is diagnosed, the next step is to determine how severe it is.1 Severity is based on three main questions:1

  • How much are asthma symptoms affecting your life?
  • How well do your lungs work?
  • How likely is an asthma attack in the next few months?

Your provider will also ask questions—and possibly do more tests—to figure out what triggers your asthma.1 Based on the severity and triggers, your provider will recommend a treatment plan. The treatment may include medications, as well as ideas for avoiding triggers.

What will my health care provider want to know about my medical history?

Your medical history provides important information about symptoms that might be caused by asthma. It will help your provider to understand which situations trigger your asthma. Tell your provider if your symptoms are worse at night. Mention if other family members with asthma or allergic diseases, such as eczema, hay fever (allergic rhinitis), or food allergies. Questions your provider may ask are in Table 1.1

Table 1. Typical questions for the initial evaluation of asthma

In the past 12 months…

  • Have you had a sudden episodes of coughing, wheezing, chest tightness, or shortness of breath?
  • Have you had colds that “go to the chest” or last longer than 10 days?
  • Have you noticed that you cough, wheeze or feel short of breath during a particular time of the year?
  • Have you noticed that you cough, wheeze, or feel short of breath when you are around animals, tobacco smoke, perfumes, or anything similar?
  • Have you used any medications that help you breathe better? How often? How well do these medications relieve your symptoms?
In the past 4 weeks, have you had coughing, wheezing, or shortness of breath…

  • At night that has awakened you?
  • When you wake up?
  • After being physically active?
Have you been diagnosed with asthma or wheezing in the past? At what age?
Do you or any close relatives have allergies, sinus infections, chronically stuffy or runny nose, eczema, nasal polyps, or asthma?

Adapted from: National Heart, Lung, and Blood Institute. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma – Full Report 2007. Accessed 11/12/14 at: http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf

What will the physical exam include?

Your provider will examine your nose, throat, chest, and skin for signs of asthma or allergies.1

  • Breaths: Your provider will note how deeply and how quickly you breathe.
  • Barrel chest: A barrel-shaped chest is usually seen in people with severe chronic asthma or COPD (chronic obstructive pulmonary disease). This can happen if the lungs are chronically expanded (“full” or “overinflated”).
  • Hunched shoulders: People with asthma tend to use the muscles of the shoulders and neck (“accessory muscles”) when they have a hard time breathing. This causes them to hunch their shoulders.
  • Wheezing sounds: People with asthma typically wheeze when they breathe out.
  • Nose: A runny nose, swelling of the nasal passages, and nasal polyps are a sign of certain types of asthma.
  • Skin: Eczema (skin inflammation) is an indication of allergies.

What is spirometry?

Spirometry is a test to measure your lung function. It is used to diagnose many different types of lung disease, including asthma.

Spirometry provides measurable (objective) information about how blocked (obstructed) your airways are.1 It is important to measure the amount of obstruction, because you cannot tell based on symptoms alone. For example, you might have asthma symptoms but normal lung function. Alternatively, your airway obstruction may be much more serious than your symptoms indicate. Spirometry is also done to check if the obstruction is “reversible.” Reversibility means that the airways open up after taking medications that relax the muscles around the airways.

What other tests help to diagnose asthma?

Other tests may be necessary if the spirometry results are unclear, or if your provider wants more information about certain triggers. Tests may also be needed to rule out other conditions. Additional tests include:1

How is asthma diagnosed in children?

Just as for adults, the diagnosis of asthma in children is based on the pattern of symptoms, risk factors, and physical examination.1,4 The medication trial typically lasts two to three months. Your child’s provider will want to see if your child’s symptoms get better with medication and get worse when the medications stop.

What happens after I am diagnosed with asthma?

Your health care provider will prescribe medications based on how severe your asthma is. Your provider will recommend ways to avoid triggers. Avoiding known triggers can reduce your asthma symptoms and the amount of medication you need.1

Your provider will want to follow-up with you to see if the medications are working. The timeframe for follow up depends on how severe your asthma is. It may range from one to six months.1 It is important to return for follow up, so that you and your provider can discuss whether more or less medication is needed.

view references
  1. National Heart, Lung, and Blood Institute. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma - Full Report 2007. Accessed 11/12/14 at: http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf
  2. Aaron SD, Vandemheen KL, Boulet LP, et al; Canadian Respiratory Clinical Research Consortium. Overdiagnosis of asthma in obese and nonobese adults. CMAJ. 2008;179:1121-1131. http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19015563/
  3. National Institute for Health and Care Excellence. Draft guideline to improve asthma diagnosis. Press release, 1/28/15. Accessed 2/7/15 at https://www.nice.org.uk/news/article/draft-guideline-to-improve-asthma-diagnosis.
  4. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2014. Accessed 11/12/14 at: www.ginasthma.org.
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