How Do Doctors Diagnose Asthma In Adults? – Signs

Asthma is a chronic lung disease that causes episodes of difficulty in breathing. It can affect people of all ages,. Early recognition and treatment of asthma is important to prevent worsening of asthma and avoid a severe asthma attack. Not recognizing early signs and symptoms of more severe asthma might delay early care and may pose a risk of hospitalization or even a life-threatening asthma attack.

How do doctors diagnose asthma in adult?

Doctor can diagnose asthma based on:

1. Presence of history and symptoms suggestive of asthma.
2. Physical examination to detect signs of asthma, nevertheless physical examination can be normal when there is no attack.
3. Objective measurement of decreased airflow in the lungs by using specific measurement like peak expiratory flow meter (PEF) and a spirometer.

Points to support diagnosis of asthma and level of asthma control

• Family history of asthma and allergies – skin eczema or a family history of asthma or atopic diseases is often associated with asthma.
• Cough – worse especially at night/early morning, awakening the patient.
• Recurrent wheeze.
• Recurrent difficulty in breathing.
• Recurrent chest tightness.
• Frequent recurrence of asthma symptoms.
• Symptoms occur or worsen in the presence of trigger e.g. exercise, respiratory tract infection, smoke (tobacco, wood) but also dust mites (in mattresses, pillows, carpets). Other triggers are pickled fruits.
• Other related health conditions that can interfere with asthma condition e.g. allergy rhinitis, sinus infections, reflux disease and psychological stress.

Physical examination

Consider asthma if any of the following signs are present :

1. Wheezing/rhonchi happens (high-pitched whistling sounds) when breaths out (however, a normal lung examination does not exclude asthma).
2. Coughing – often worse at night or early in the morning, making patient difficult to sleep or a patient is startled from sleep due to wheezing, cough or breathlessness.
3. Signs of allergies include :
   • Runny nose
   • Swollen nasal turbinates
   • Allergic skin conditions (such as eczema)

Patients can still have asthma even if they do not show these signs when the doctor examines them because asthma and allergy signs are usually intermittent and episodic.

Signs of worsening asthma

Asthma signs range from none to severe and vary from patient to patient. Patients may have infrequent asthma attacks, show asthma signs only on certain times like when they are exercising or have chronic signs all the time. Signs that the asthma is probably worsening include :

1. Asthma signs e.g. wheezing that are more frequent and troublesome.
2. Increasing breathlessness (measurable with a peak flow meter – or spirometer).
3. The need to use a quick-relief inhaler more often for example using the reliever more than two times per day.
4. Asthma signs can flare-up in certain situations :
   • Exercise-induced asthma, which may be worse when the air is cold and dry
   • Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust
   • Allergy-induced asthma, triggered by particular allergens, such as pet dander, cockroaches or pollen
     

Signs of an asthma emergency

Severe asthma attacks can be life-threatening. Therefore, it is important for the patient to work with their doctor proactively to recognize asthma triggers, thus avoiding them and when do their signs and symptoms of asthma worsen and when they should seek emergency to take appropriate actions treatment. Signs of an asthma emergency include :

• Rapid worsening of breathlessness or wheezing
• No improvement even after using a quick-relief inhaler
• Breathlessness even when the patients are doing minimal physical activity

Conclusion

Asthma is a chronic lung disease that can cause episodic symptoms and signs which can interfere with daily activities or even leads to fatal attack. Early recognition of asthma signs with proper treatment can prevent both short-term and long-term complications of asthma.

References

1. National Heart, Lung, and Blood Institute. What is asthma? http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/. Accessed May 6, 2013.
2. McPhee SJ, et al. Current Medical Diagnosis & Treatment 2012. 51st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=2740. Accessed May 6, 2013.
3. Parker MJ. Asthma. Otolaryngologic Clinics of North America. 2011;44:667.
4. Asthma and Allergy Foundation of America. Asthma overview – diagnosis. http://www.aafa.org/display.cfm?id=8&cont=7. Accessed May 6, 2013.
5. Ronald B. George, Richard W. Light, Richard A. Matthay, Michael A. Matthay. Asthma. In Chest Medicine: Essentials Of Pulmonary And Critical Care Medicine May 2005, 5th edition.
6. Ministry Of Health Malaysia. Clinical Practice Guidelines For Management Of Adult Asthma 2002.
7. Global Strategy for Asthma Management and Prevention: Global Initiative for Asthma (GINA) (Updated 2012)