Diagnosing and treating asthma
When should you see a doctor?
- If you suspect asthma due to persistent signs (symptoms that last more than a few days). Early treatment can prevent long-term damage to the lungs or worsening of symptoms over time.
- If your symptoms begin to worsen. It can happen that medications may not alleviate symptoms sufficiently. Overuse of medication can cause side effects which can worsen asthma. A person may also find that they need to use a quick-relief inhaler more frequently than before. Any changes in symptoms should be carefully monitored by a doctor.
- To monitor and control asthma, as well as review treatment plans. It is strongly advisable to see your doctor periodically once asthma has been diagnosed. Long-term control will help to alleviate symptoms and prevent attacks which can be life-threatening. As a condition, asthma typically changes over time, so treatment adjustments are needed in order to keep it under control.
What can you expect from your initial appointment?
A family doctor or general practitioner (GP) is the best place to start. He or she may feel it necessary to refer you to an allergist or a pulmonologist following an initial assessment.
Your doctor will ask a series of questions in order to make a diagnosis and better understand the nature of your condition in case they need to refer you to a specialist.
Questions can include:
- What symptoms are you experiencing?
- When did your symptoms begin?
- Would you describe your symptoms as mild or severe?
- Are you aware of any allergies? Do you have problems with hay fever?
- Have you had bronchitis frequently?
- Does anyone in your family suffer from an allergy or have asthma?
- Have you noticed anything that may worsen or improve your symptoms?
- Do you have or are you already treating a chronic condition?
- How frequently do you exercise and what do you do?
- What sort of diet do you have?
- What type of home and work environment do you have?
How you answer these questions will help your doctor to not only diagnose asthma, but also classify the severity of the condition. Your doctor will need to do this in order to determine the best means of treatment. This will become a repetitive process once diagnosed as well. The degree of severity changes over time, and means that your treatment plan will continuously need to be adjusted.
The four asthma classification categories are:
- Mild intermittent (the patient experiences mild symptoms up to 2 days a week or up to 2 nights a month)
- Mild persistent (the patient experiences symptoms more than twice a week, but not more than once in a single day)
- Moderate persistent (the patient experiences symptoms at least once a day or more than one night in a week)
- Severe persistent (the patient experiences symptoms on most days / throughout the day and frequently at night)
Diagnosis and tests
Your doctor will want to perform a physical exam, not only to diagnose asthma, but also rule out any other potential conditions, such as respiratory infections or COPD (chronic obstructive pulmonary disease).
Your doctor will also perform a series of tests to assess your breath (or ability to breathe comfortably).
Pulmonary function tests can include:
- Spirometry test: This estimates how much air you are able to exhale following a deep breath, as well as how quickly you are able to breathe out. The test is used to help determine the narrowing of your bronchial tubes.
- Peak flow test: A device is used to measure how hard you are able to exhale. Low peak flow readings can signal an impairment in lung function (your lungs may not be working well or an asthmatic condition may be worsening / becoming more severe).
These types of tests are commonly performed before and after taking a bronchodilator (medication to open the airways). An improvement in lung function once this medication has been taken can mean that you have asthma.
Other tests performed to make a diagnosis include:
- Allergy testing: A skin or blood test can help to identify a potential allergy to pets, pollen, mould or dust. This will help to determine a potential allergy trigger.
- Provocative testing: Airway obstruction may be measured before and after strenuous physical activity (exercise-induced asthma) or taking in several breaths of cold air (asthma triggered by weather changes).
- Methacholine challenge: A known asthma trigger, methacholine will cause mild constriction of the airways when inhaled. A reaction may help to determine an asthma diagnosis.
- Sputum eosinophils: A sample of saliva and mucus during coughing will be taken for testing. Eosinophils (white blood cells) are typically present when symptoms develop. These will be visible to your doctor when he or she uses a rose-coloured dye (eosin) on the sample.
- Chest X-ray and CT scan: Imaging tests of the lungs and sinuses (nose cavities) can help to identify or diagnose any infections and abnormalities causing or aggravating normal breathing function.
- Nitric oxide test: Your doctor may wish to measure the amount of nitric oxide (gas) you may have in your breath. Higher than normal levels indicate inflammation in the airways and can be a sign of asthma.
Treatments and medications
Your doctor will recommend a course of treatment that provides you with long-term control, and preventative measures to help make living with the condition more comfortable. It will be a flexible plan that can be adjusted easily as your symptoms change or based on how you respond to treatment options.
A plan involves learning to recognise the key triggers for your condition, and signs of a potential attack. You will also be well informed about how to avoid causes, as well as what steps to take when experiencing adverse reactions. Your doctor will advise on how to go about tracking your breathing (using a peak flow metre) and how to best keep your symptoms under control with medications (taken daily). Flare-ups can also be controlled with quick-relief inhalers (bronchodilators). These open narrowed airways quite quickly, allowing a sufferer to breathe more easily.
Your day-to-day treatment plan may include the following:
- Medications: Your age, symptoms, triggers and classification will help to determine which medications will best treat your condition. Long-term control medications work to reduce inflammation and help prevent the occurrence of symptoms leading to an attack. These can include inhaled corticosteroids, leukotriene modifiers (taken orally), long-acting beta agonists (inhaled), theophylline (taken orally) and combination inhalers. Your doctor may prescribe quick-relief medications for rapid, short-term symptom treatment during an asthma attack. These can either be in the form of portable, hand-held inhalers, nebulisers (inhaled through a mouthpiece or face mask) or oral medications. Allergy medications may also be prescribed, if allergies are predominant triggers. These can include immunotherapy (allergy shots) and omalizumab injections, which can help to alleviate immune system reactions.
- Bronchial thermoplasty: Commonly used for severe asthma that shows little to no improvement through inhaled corticosteroid treatment or other long-term asthma medications. This treatment option reduces airway tightening with the use of an electrode.