Asthma is a chronic lung disease characterized by inflammation of the bronchi and narrowing of the airways, causing symptoms such as shortness of breath, wheezing, coughing and chest tightness. About 226 million people worldwide suffer from asthma. The diagnosis of asthma usually involves a comprehensive medical evaluation, including a physical examination, a review of the medical history, and diagnostic tests, such as spirometry and other lung function tests, to make a final diagnosis and assess the severity of the condition.
Primary care providers and pediatricians are often the first to diagnose asthma, but allergists (doctors who specialize in allergic conditions) and pulmonologists (doctors who specialize in lung disease) diagnose asthma and its effects on the airways. Other conditions that can affect you can be diagnosed and treated. It is important to see your doctor if you have asthma symptoms. Asthma is a lifelong condition that often requires ongoing treatment. The earlier you are diagnosed, the sooner you can start treatment to control your symptoms and reduce the risk of complications.
Diagnostic Requirements
Asthma diagnosis criteria are based on symptoms, medical history, physical exam results, and lung function testing. The Global Initiative for Asthma (GINA) criteria, produced by a group of international respiratory medicine specialists, and the National Asthma Education and Prevention Program (NAEPP) recommendations are the most often used criteria for asthma diagnosis.
To establish an asthma diagnosis, the GINA criteria consider four major factors:
Symptoms:
Coughing, wheezing, shortness of breath, and chest tightness are common asthma symptoms that vary in intensity and duration.
Variation in lung function has been documented:
Asthmatics have variable lung function, which means that breathing and lung capacity might deteriorate in response to certain stimuli, such as exercise. Your doctor may do numerous lung function tests to search for changes in how your lungs work.
Hyperresponsiveness of the airways:
Hyperresponsive airways constrict excessively in response to a variety of signals, such as exercise or cold air. Bronchial challenge tests are used to determine the sensitivity of your airways throughout the asthma diagnostic process.
Alternative diagnosis are ruled out:
Your healthcare professional will rule out illnesses like heart failure, chronic obstructive pulmonary disease (COPD), or bronchiectasis before making an asthma diagnosis.
Health Background
In order to assist your healthcare professional in diagnosing asthma, a thorough assessment of your medical history might yield valuable information. In order to rule out or diagnose asthma, they will analyze your medical history and take into account a number of important criteria, which may include:
Signs:
Your doctor will inquire about the nature, frequency, and duration of your symptoms as well as when they first appeared. Additionally, they will inquire as to if anything—such as exercise, cold air, pollen, or cigarette smoke—triggers or exacerbates your symptoms.
Health issues:
Inform your physician of all current and prior medical issues. Asthma risk factors include allergic rhinitis and chronic obstructive pulmonary disease (COPD), which can also resemble asthma symptoms.
Usage of medication:
Your doctor will want to know about all of your current medications since some medications, including beta-blockers or non-steroidal anti-inflammatory drugs (NSAIDs), might exacerbate asthma symptoms.
Family background:
Those who have a family history of allergies or asthma are more likely to develop asthma.
Exposure to the environment:
Your doctor will inquire about possible exposure to allergies and lung irritants at work and at home.
Physical Inspection
Your doctor will examine you physically to check for asthma symptoms and indicators. They will listen to your lungs as you breathe throughout the examination. In addition, they will measure your respiration rate and search for evidence of shallow or quick breathing. To find out how much oxygen is in your blood, you can put a pulse oximeter on your finger.
Lung Function Tests
To confirm or rule out asthma, lung function tests, also known as pulmonary function tests, assess many elements of your respiratory health. Spirometry, peak flow meters, fractional exhaled nitric oxide (FeNO) testing, and bronchial provocation tests are some of these examinations.
Respirometry
A non-invasive examination called spirometry gauges how quickly and how much air can enter and exit your lungs. You will be required to inhale deeply into a spirometer machine and swiftly and violently expel during the exam. Results of spirometry include:
- Forced vital capacity (FVC): The volume of air that can be exhaled following a deep inhalation.
- Forced expiratory volume (FEV1): The volume of air that may be expelled in the first second
The findings will be compared to what is typical for your age, gender, height, and race by your healthcare professional. Your FEV1 reading may be below average if you have asthma.
The FEV1/FVC ratio may be computed using these values. The proportion of your lung capacity that you can exhale in one second is shown by this value. If your child's FEV1/FVC ratio is less than 85%, they have a low ratio. Less than 70% is the equivalent for grownups.
Peak Flow Measurement
A peak flow meter is a portable gadget that gauges the highest airflow rate you can produce with a hard exhale. In order to test a peak flow meter, inhale deeply and expel strongly into the device. Your score indicates whether or not your airways are narrowing based on the meter's measurement of how quickly you exhale. Three "zones" are identified by these scores:
Green zone: Your asthma is now under control if you are able to exhale at 80–100% of your typical peak flow rate.
Yellow zone: You are in the cautious range if you can exhale between 50 and 80 percent of your typical peak flow rate. It's critical to act and obtain the necessary medical care.
Red zone: You are in the medical alert area if you exhale at 50% or less of your typical peak flow rate. Get medical help right now.
The outcome might differ based on the method used by each individual. To get the best results, it is advised that you measure your peak flow on a regular basis to have a clear grasp of your baseline.
FeNO Examination
The exhaled nitric oxide (NO) level in your breath is determined by the fractional exhaled nitric oxide (FeNO) test. NO indicates a particular period of airway inflammation.
You will exhale gently and steadily into a device that measures the amount of NO in your breath during the test. The inflammation of the airways brought on by asthma raises the concentration of NO. Asthma's primary characteristic, airway inflammation, is indicated by high NO levels. The FeNO test plays a crucial role in the diagnosis of eosinophilic asthma, a subtype of asthma distinguished by elevated eosinophil counts, a particular kind of white blood cell.
Tests for Bronchial Provocation
The methacholine challenge test, also known as the bronchial provocation test, assesses the sensitivity or reactivity of your airways.
In order to obtain a baseline reading, your healthcare professional will first ask you to breathe into a spirometer. After that, you'll receive a little dosage of methacholine, an asthma medication. We'll do the spirometer test again to see how the methacholine affected your airways. The test findings will be positive if the methacholine reduces your breathing capacity by 20% or more when compared to your baseline, which suggests that your airways are reactive and you could have asthma.
Allergy testing
Allergy testing may be recommended if you develop asthma symptoms after exposure to an allergen. If you suspect that allergies are causing your asthma symptoms, your doctor may recommend allergy testing. Common allergy tests include:
The skin prick test :
Your skin is rubbed with a little quantity of a suspected allergen to allow the allergen to penetrate the skin. The skin is inspected to look for allergy-related symptoms including redness, swelling, and/or itching.
Test for immunoglobulin E (IgE):
This is a blood test that measures the amount of immunoglobin E (IgE) in the blood. IgE is antibodies the immune system produces in response to an allergen. High levels can indicate an allergy to airborne allergens that can cause or worsen asthma symptoms, such as mold, pet dander, or pollen.
Imaging Examinations
Although imaging tests are not frequently used to diagnose asthma, doctors may order them to rule out other illnesses that might produce symptoms similar to asthma or to diagnosis asthma in young children whose lung function tests are not reliable enough to detect the condition. These will most likely consist of sinus imaging, an acid reflux test, or a chest X-ray.
Screening for Conditions That Are Related
In order to accurately diagnose asthma, medical professionals must rule out other illnesses that may present with same symptoms. Before diagnosing asthma, your healthcare professional could conduct further imaging tests or diagnostic procedures to rule out the following conditions:
Screening for associated diseases
To accurately diagnose asthma, your doctor must rule out other conditions that may cause similar symptoms. Before making a diagnosis of asthma, your doctor may order additional imaging tests or diagnostic procedures to rule out the following conditions:
Chronic obstructive pulmonary disease (COPD):
COPD is a group of respiratory diseases that share symptoms with asthma, including shortness of breath, coughing and wheezing.
Bronchiectasis:
This is a condition where the airways become damaged and dilated, making it difficult to clear mucus from the lungs. It caused asthma-like symptoms, including coughing, wheezing and shortness of breath.
Vocal cord dysfunction (VCD):
VCD is the compression and narrowing of the vocal cords that prevents them from opening properly. VCDs can mimic asthma symptoms such as wheezing and shortness of breath.
Congestive heart failure (CHF):
CHF occurs when the heart cannot pump enough blood to meet the body's needs. CHF shares some symptoms with asthma, such as shortness of breath and wheezing, but other symptoms, such as leg swelling and fatigue, also accompany heart failure.
Gastroesophageal reflux disease (GERD):
This is a digestive disorder in which stomach acid backs up into the esophagus, causing irritation and inflammation. GERD can cause symptoms such as chest pain, coughing and wheezing that can be mistaken for asthma. GERD symptoms usually worsen after eating or lying down.
In addition to ruling out these conditions, your doctor can check for comorbidities that are common in people with asthma. Comorbidities of asthma include:
- Obstructive sleep apnea
- Allergy
- Rhinitis (swelling of the nasal lining, usually caused by allergies)
- Obesity
- Anxiety and depression
A Brief Recap
Your healthcare professional will carefully review your medical history, test findings, and symptoms in order to diagnose asthma. Asthma can be diagnosed with the aid of lung function tests, such as spirometry and FeNO testing. Tests for allergies, blood, and imaging may also be utilized.
Your doctor has to rule out other illnesses including COPD, bronchiectasis, and vocal cord dysfunction that can resemble the symptoms of asthma. They could do a screening for co-occurring diseases including allergies, GERD, and obstructive sleep apnea that are frequently linked to asthma.
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