Diagnosing and

Diagnosing Asthma

doctors consulting

Asthma diagnoses are based on three core components: a medical history, a physical exam, and results from breathing tests. A primary care physician will administer tests and, if you have asthma, determine your level of asthma severity as intermittent, mild, moderate, or severe.

Medical History

A detailed family history of asthma and allergies can help your doctor make an accurate asthma diagnosis. Your own personal history of allergies is also important as many are closely linked to asthma.

Information about asthma symptoms is also useful. Be prepared to divulge when and how often they occur and what factors seem to exacerbate or worsen symptoms. Common symptoms and signs include:

Wheezing
Coughing
Breathing difficulty
Tightness in the chest
Worsening symptoms at night
Worsening symptoms due to cold air
Symptoms while exercising
Symptoms after exposure to allergens

It is also wise to make note of health conditions that can interfere with asthma management such as runny nose, sinus infections, acid reflux disease, psychological stress, and sleep apnea.

It is often somewhat harder to diagnose young children who may develop their first asthma symptoms before age 5. Symptoms are likely to be confused with those of other childhood conditions, but young children with wheezing episodes during colds or respiratory infections are likely to develop asthma after 6 years of age.


Physical Exam

A physical examination will generally focus on the upper respiratory tract, chest, and skin. A doctor will use a stethoscope to listen for signs of asthma in your lungs as you breathe. The high-pitched whistling sound while you exhale - or wheezing - is a key sign of both an obstructed airway and asthma.

Physicians will also check for a runny nose, swollen nasal passages, and nasal polyps. Skin will be examined for conditions such as eczema and hives, which have been linked to asthma.

Physical symptoms are not always present in asthma sufferers, and it is possible to have asthma without presenting any physical maladies during an examination.


Asthma Tests

Lung function tests, or pulmonary function tests, are the third component of an asthma diagnosis. To measure how much air you breathe in and out and how fast you can blow air out, physicians administer a spirometry test.

Spirometry is a noninvasive test that requires you to take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer. The spirometer then displays two key measurements:

Forced vital capacity (FVC) - the maximum amount of air one can inhale and exhale
Forced expiratory volume (FEV-1) - the maximum amount of air exhaled in one second

The measurements are compared against standards developed for a person's age, and measurements below normal may indicate obstructed airways.

It is common for a doctor to administer a bronchodilator drug to open air passages before retesting with the spirometer. If results improve after the drug, there is a higher likelihood of receiving an asthma diagnosis.

Children younger than 5 years of age are difficult to test using spirometry, so asthma diagnoses will rely mostly on symptoms, medical histories, and other parts of the physical examination. It is common for doctors to prescribe asthma medicines for 4 to 6 weeks to see how a young child responds.


Other Tests

A "Challenge Test" (or bronchoprovocation test) is when a physician administers an airway-constricting substance (or something as simple as cold air) to deliberately trigger airway obstruction and asthma symptoms. Similarly, a challenge test for exercise-induced asthma would consist of vigorous exercise to trigger symptoms. A spirometry test is then administered, and if measurements are still normal, an asthma diagnosis is unlikely.

Physicians use allergy tests to identify substances that may be causing or worsening asthma. These tests cannot be used to diagnose asthma, but they can be used to understand the nature of asthma symptoms.

Doctors may also test for another disease with similar symptoms as asthma, such as reflux disease, heartburn, hay fever, sinusitis, sleep apnea, chronic obstructive pulmonary disease (COPD), airway tumors, airway obstruction, bronchitis, lung infection (pneumonia), blood clot in the lung (pulmonary embolism), congestive heart failure, vocal cord dysfunction, and viral lower respiratory tract infection.

Tests may be administered for these ailments such as chest x-rays, EKGs (electrocardiograms), complete blood counts, CT (computerized tomography) scans of the lungs, gastroesophageal reflux assessment, and sputum induction and examination.

A new test using exhaled nitric oxide is being evaluated since physicians are looking for a test that is more accurate than spirometry. Higher levels of nitric oxide are linked to higher degrees of asthma severity. The current drawback lies in the high cost of the test and the specialized equipment required to measure this chemical marker.

An asthma specialist can usually be avoided as most primary care physicians are capable of diagnosing asthma. An asthma specialist may be necessary, however, if you need special asthma tests or have had a life-threatening asthma attack in the past. In addition, specialists can be of use if you need more than one kind of medicine or higher doses of medicine in order to control your asthma, if you have overall difficulty controlling asthma, or if you will be receiving allergy treatments.

Treatment for Asthma

doctor with store of drugs

Asthma is not so much "treated" as it is "controlled". As a chronic, long-term disease, there is no cure. However, there are tools and medicines to help you control asthma as well as benchmarks to gauge your progress.

The Peak Flow Meter

A peak flow meter is a simple, small, hand-held tool that can help you maintain control of asthma by providing a measurement of how well air moves out of the lungs.

After blowing into the device, the meter reveals your peak flow number. A physician will indicate how often to test as well as how to interpret the result to determine the amount of medication to take. Some people record scores every morning while others use the peak flow meter intermittently.

Often, each test with the peak flow meter will be judged against your "personal best" peak flow number (found during 2 to 3 weeks of good asthma control). If peak flow tests begin to decline - even before other symptoms are present - it may indicate a looming asthma attack. After taking asthma medication, the peak flow meter can be used to test the effectiveness of drug therapy.


Good Control

Asthma is considered "well-controlled" if:

  • Chronic and troublesome symptoms (coughing and shortness of breath) are prevented and occur no more than 2 days per week.
  • There is little need for quick-relief medicines or they are needed less than 2 days per week.
  • You maintain good lung function.
  • Your activity level remains normal.
  • Your sleep level remains normal and symptoms do not wake you from sleep more than 1 to 2 nights per month.
  • You do not need emergency medical treatment.
  • You have no more than one asthma attack each year that requires inhalation of corticosteroids.
  • Your peak flow stays above 80% of your personal best number.

These benchmarks can be obtained by working with a doctor and avoiding factors that can make your asthma flare up. Also be sure to treat other conditions that may interfere with asthma management.

Good control also means avoiding things that trigger asthma or asthma symptoms such as allergens. This may mean limiting time spent outdoors when pollen levels or air pollution levels are highest and limiting contact with animals. Asthma linked to allergies can also be suppressed by getting the necessary allergy shots.


Preventive Checkups

Part of good asthma control is seeing a doctor every 2 to 6 weeks for regular checkups until it is under control. Then checkups may be reduced to once a month or twice a year.

It is a good habit to keep track of asthma symptoms and attacks and diagnostic numbers such as the peak flow measurement. Doctors and nurses will ask about these and about daily activities in order to gauge the status of your asthma control.


Medicine

medicine

Medication for asthma is broadly categorized as either quick-relief medicine or long-term control medicine. Reducing airway inflammation and preventing asthma symptoms is the goal of long-term control medicines, where as immediate relief of asthma symptoms is the goal of quick-relief or "rescue" medicines.

Medications can be ingested in pill form, but most are powders or mists taken orally using a device known as an inhaler. Inhalers permit medicines to travel efficiently through the airways to the lungs.


Inhaler

Medication may also be administered using a nebulizer, providing a larger, continuous dose. Nebulizers vaporize a dose of medication in a saline solution into a steady stream of foggy vapor that is inhaled by the patient.


Long-Term Control

Long-term control medicines are taken every day and are designed to prevent asthma symptom such as airway inflammation. Inhaled corticosteroids are the most effective long-term control medicine - the best at relieving airway inflammation and swelling. They are usually taken daily to greatly reduce the inflammation that initiates the chain reaction of the asthma attack.

Even if taken every day, inhaled corticosteroids are not habit-forming. However, the medicines do have side effects such as the mouth infection known as "thrush". Thrush occurs when the corticosteroids land in your throat or mouth. Spacers or holding chambers have been developed to help avoid this. Thrush can also be avoided by rinsing the mouth out after inhalation.

Inhaled corticosteroids also increase the risk of cataracts (clouding of the eye's lens) and osteoporosis (weakening of the bones) if taken for long periods of time.

There are other long-term control medicines available that doctors may prescribe. Most of them are taken by mouth and are designed to open the airways and prevent airway inflammation. Examples include inhaled long-acting B2-agonists (used with low-dose inhaled corticosteroids), leukotriene modifiers, cromolyn and nedocromil, and theophylline.


Quick-Relief Medicines

Quick-relief medicines relieve asthma symptoms when they occur. The most common of these are inhaled short-acting B2-agonists - bronchodilators that quickly relax tight muscles around the airways, allowing air to flow through them.

The quick-relief inhaler should be used when asthma symptoms are first noticed, but should not be used more than 2 days a week. Most people carry the quick-relief inhaler with them at all times. Quick-relief medicines usually do not reduce inflammation and therefore should not be used as a replacement for long-term control medicines.


Emergency Care

doctor attending to patient

If your medicines do not relieve an asthma attack or your peak flow is less than half of what it normally is, emergency medicine may be necessary. Call 911 or have someone take you to the emergency room if you cannot walk because you are out of breath or if you have blue lips or fingernails.

Lifesaving treatments at the hospital will consist of direct oxygen (to alleviate hypoxia) and higher doses of medicines. Emergency personnel will likely administer a cocktail of short-acting B-2 agonists, systemic oral or intravenous steroids, other bronchodilators, nonspecific injected or inhaled B-2 agonists, anticholinergics, inhalation anesthetics, the dissociative anesthetic ketamine, and intravenous magnesium sulfate.

Intubation (a breathing tube down one's throat) and mechanical ventilation may also be used in patients undergoing respiratory arrest.


Children

Although quick-relief medicines can relieve wheezing in young children, long-term control medicines will be used to treat infants and young children if symptoms are likely to persist after 6 years of age.

Like adults, children are treated with inhaled corticosteroids, montelukast, or cromolyn. Often, treatments will be tried for 4 to 6 weeks and stopped if the desired outcome is not seen. Inhaled corticosteroids carry the side-effect of slowed growth, but the effect is generally small and is only apparent for the first few months of treatment.


Elderly

Elderly asthma care may require adjustments to prevent interactions between medicines. Beta blockers, aspirin, pain relievers, and anti-inflammatory medicines can prevent asthma medicines from working correctly and may worsen symptoms. In addition, it may be difficult for older persons to hold their breath for 10 seconds after inhalation of medicines, but spacers have been developed to help this issue.

The increased osteoporosis risk brought on by inhaled corticosteroids may be magnified in older adults with weak bones. It is common to take calcium and vitamin D pills, among other therapies, to keep bones healthy.


Pregnant Women

Proper asthma control is necessary for pregnant women in order to ensure a good supply of oxygen to the fetus. Babies born of asthmatic mothers have a higher chance of premature birth and lower birth weight. For pregnant women, the risks associated with having an asthma attack outweigh any risks associated with asthma medicines.


Non-medical Treatments

Some people treat asthma using unconventional alternative therapies, but there is little formal data to support the effectiveness of these methods. There is research, however, that has found acupuncture, air ionizers, and dust mite control measures, to have little or no effect on asthma symptoms or lung function. Evidence is inconclusive to support or reject osteopathic, chiropractic, physiotherapeutic, and respiratory therapeutic techniques. Homeopathy may mildly reduce the intensity of symptoms, but this finding is not robust.

Famous People with Asthma

Sports

Jerome Bettis - professional football player
Bruce Davidson - Olympic equestrian
Tom Dolan - Olympic medalist, swimming
Kurt Grote - Olympic medalist, swimming
Nancy Hogshead - Olympic medalist, swimming
Jim "Catfish" Hunter - professional baseball player
Miguel Indurain - Tour de France winner (5 times) and Olympic champion
Jackie Joyner-Kersee - Olympic medalist, track
Bill Koch - Olympic medalist, cross-country skiing
Greg Louganis - Olympic medalist, diving
Tom Malchow - Olympic medalist, swimming
Debbie Meyer - Olympic medalist, swimming
Art Monk - professional football player
George Murray - wheelchair athlete & Boston Marathon winner
Robert Muzzio - decathlete
Paula Radcliffe - world record holder marathon
Dennis Rodman - professional basketball player
Jim Ryun - Olympic medalist, track
Alberto Salazar - marathon runner
Mark Spitz - Olympics medalist, swimming
Alison Streeter - crossed the English channel a record 43 times
Isaiah Thomas - professional basketball player
Jan Ullrich - Tour de France winner
Amy VanDyken - Olympic medalist, swimming
Dominique Wilkins - professional basketball player
Kristi Yamaguchi - Olympic medalist, figure skating


Entertainment

Steve Allen - comedian, actor
Loni Anderson - actress
Jason Alexander - actor, director
Ludwig von Beethoven - composer
Leonard Bernstein - conductor, composer
Judy Collins - folk singer
Alice Cooper - rock singer
DMX - rapper
Morgan Fairchild - actress
Kenneth Gorelick (Kenny G) - musician
Bob Hope - comedian, actor
Billy Joel - singer
Robert Joffrey - dancer, choreographer
Diane Keaton - actress
Liza Minelli - actress, singer
Arnold Schoenburg - composer
Martin Scorsese - film director
Paul Sorvino - actor
Sharon Stone - actress
Elizabeth Taylor - actress
Apex Twin - techno DJ
Antonio Vivaldi - composer, conductor
Orson Welles - actor, director


Literature

Ambrose Bierce - journalist and author
Elizabeth Bishop - poet and author
Charles Dickens - author
Oliver Wendell Holmes - poet, physician, inventor
Samuel Johnson - 18th century poet, critic, essayist
Joseph Pulitzer - publisher, philanthropist
Dylan Thomas - poet, playwright
John Updike - author
Edith Wharton - author


Politics

Calvin Coolidge - 30th President of the U.S.
Bill Clinton - 42nd President of the U.S.
Benjamin Disraeli - British statesman, author
Che Guevara - South American revolutionary leader
Rev. Jesse Jackson - political leader
John F. Kennedy - 35th President of the U.S.
John Locke - 17th century politician, philosopher
Walter Mondale - 42nd Vice President of the U.S.
Peter the Great - Russian Czar
Theodore Roosevelt - 26th President of the U.S.
Seneca - Roman philosopher and politician
William T. Sherman - hero of the American civil war
Daniel Webster - lawyer, statesman
William III of England (1650-1702) - Prince of Orange, King of England, Scotland and Ireland
Woodrow Wilson - 28th President of the U.S.


Science

Baruj Benacerraf - Nobel Prize Winner in medicine
E.J. Corey - Nobel Prize Winner in chemistry
Beruj Benacerraf - Immunologist, Nobel Prize winner
Jan Baptista van Helmont - Belgian pioneer in medicine and chemistry

Living with Asthma

couple kissing

Asthma should not stop anyone from leading an active, healthy life. The chronic condition requires proper long-term care, active management, and adherence to an asthma action plan. Asthma can be a stressful condition to manage, and stress can even trigger asthma attacks. Asthmatics should strive to reduce stress as much as possible and learn to cope with the challenges and frustrations of living with asthma in a positive way.

Day-to-day living may be more manageable if you can find support from other people who are also living with asthma. Online forums also exist for people to share experiences, opinions, and frustrations. Support is equally important for children and teens with asthma.

An important part of managing asthma is adopting a healthy lifestyle. Eat a healthy diet rich in fruits and vegetables and low in fats and sugars, get plenty of rest, exercise regularly, work on managing stress, and, of course, do not smoke.


The Asthma Action Plan

You and your doctor should design your personal asthma action plan. The plan should consist of instructions for medication, a list of asthma triggers, responses to worsening symptoms, and benchmarks to indicate the level of your asthma control. Typical plans also include instructions for dealing with emergencies such as asthma attacks. A plan is only useful if it is followed, and successful asthma management is no exception.


Education

Learning as much as possible about asthma will help you to properly manage the condition. You should know what causes your symptoms, how to prevent them, and how to use your medicines correctly. Educate yourself about controlling symptoms and reducing asthma attacks, and be aware of barriers that may prevent you from doing so. Never hesitate to ask your physician for assistance with any issues that may arise.

Collect data about yourself on a regular basis. Record asthma symptoms and their triggers, and use a peak flow meter to measure and record how well your lungs are working. Information gathered over time can be used to track changes and progress. You will become more informed about how your body responds to the environment, and you will be quicker to spot problems and prevent attacks.


Avoid Triggers

Identifying and avoiding asthma triggers will help you to maintain an active and healthy lifestyle with asthma. The following list discusses common triggers and suggests ways to handle them:

Tobacco smoke - avoid inside and outside of the home
Air pollution - try antihistamine medications and staying indoors
Pollen - try antihistamine medications and staying indoors
Animal dander - keep pets outside, wash them often, find them a new home
Viral infections - see a physician
Heavy exercise - lower the impact of your exercise routine and consult a doctor
Stress - many methods of stress reduction exist, including breathing, meditation, progressive relaxation, and exercise.
Dry or cold air - wear a scarf over your mouth and nose during winter months
Dust mites - keep sheets, blankets, pillows, and stuffed toys clean
Sulfites in dried food and wine - avoid foods with allergens
Combustion particles - minimize exposure to combustion particles and gases, change furnace filters, and do not use a gas stove to heat the home
Deodorants, perfumes, air fresheners, paint, and cleaners - avoid if possible

Preventive Care

Schedule regular visits with the physician that helps you manage asthma so that you can assess your level of asthma control. Checkups are usually recommended every 6 to 12 months for mild intermittent or mild persistent asthma that has been well-controlled for at least 3 months. Those with moderate persistent asthma should be checked up every 3 to 6 months, and those with uncontrolled or severe persistent asthma should be checked every 1 to 2 months.

You may have to make adjustments to your asthma action plan if it is not working right for you. Your physician will consult with you to find the best plan that meets your needs.

Additionally, get regular treatment for any conditions that may interfere with your asthma management. Keeping all aspects of asthma under control is the key to living with it successfully.


Indications of Worsening Asthma

Your asthma may be getting worse if:

  • Your symptoms start to occur more often and are more intense
  • Your symptoms bother you at night, causing you to lose sleep or wake during the night
  • Your symptoms require you to limit normal activities and miss school or work
  • Your peak flow number is low relative to your personal best or it is wildly inconsistent
  • Asthma medicines do not work well
  • You are using your quick-relief inhaler more often (i.e., every day is too often)
  • You have an attack that requires an emergency room visit

Children and Teens

Children aged 10 or older should be involved in developing and following their asthma action plan. However, you will need to be sure that the plan is followed in order for it to work. It is imperative to bring your child to doctor's appointments or visits with allergy and lung specialists. A physician will be the key to making sure you and your child understand the asthma action plan

You should talk to your child about asthma and how to control it. Protect your child from secondhand smoke in your home and in public places, and prevent your child from coming into contact with common asthma triggers such as pollen, dust mites, cockroaches, or pet dander.

Make sure your child receives his or her asthma medication, and teach your child how to use medical devices properly such as peak flow meters by actively participating in asthma management.

Teens may require some extra attention, as they will see the disease as a barrier to their independence. Support and encouragement will help teens follow their asthma action plans. It is important to help teens remember that asthma will not ruin their lives. Consider allowing them to visit physicians alone to encourage them to manage care independently.

It is important for your child or teen to be active, participating in everyday kid activities and play.

A plan that allows teens to participate in sports and exercise is ideal. Additional support may be found by introducing your child to other teens or children who have asthma.

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