Asthma Health Article

Diagnosis

Early diagnosis is critical to proper asthma treatment and management. Asthma may be diagnosed by the child's primary pediatrician or an asthma specialist, such as an allergist.

The diagnosis of asthma may be strongly suggested when the typical symptoms and signs are present, including coughing, wheezing, shortness of breath, rapid breathing, or chest tightness. The physician will question the child (if old enough to provide an accurate history of symptoms) or parent about his or her physical health (the medical history), perform a physical examination, and perform or order certain tests to rule out other conditions.

The medical and family history help the physician determine if the child has any conditions or disorders that might be the cause of asthma. A family history of asthma or allergies can be a valuable indicator of asthma and may suggest a genetic predisposition to the condition. The physician will ask detailed questions about the child's symptoms, including when they first occurred, what seems to cause them, the frequency and severity, and how they are being managed.

During the physical exam, the pediatrician will listen to the patient's chest with a stethoscope to evaluate distinctive breathing sounds. He or she also will look for maximum chest expansion during inhalation. Hunched shoulders and contracting neck muscles are signs of narrowed airways. Nasal polyps or increased amounts of nasal secretions are often noted in patients with asthma. Skin changes, like atopic dermatitis or eczema, may demonstrate that the patient has allergic problems.

When asthma is suspected, the diagnosis can be confirmed using certain respiratory tests. Spirometry is a test that measures how rapidly air is exhaled and how much air is retained in the lungs. Usually the child should be at least five years of age for this test to be successful. During the test, the child exhales and the spirometer measures the airflow, comparing lung capacity to the normal range for the child's age and race. The child then inhales a drug that widens the air passages (a short-acting bronchodilator) and the doctor takes another measurement of the lung capacity. An increase in lung capacity after taking this medication often indicates the asthma symptoms are reversible (a very typical finding in asthma). The spirometer is similar to the peak flow meter that patients use to keep track of asthma severity at home.

Often, it is difficult to determine what is triggering asthma attacks. Allergy skin testing may be performed, especially if the doctor suspects the child's symptoms are persistent. An allergic skin response does not always mean that the allergen being tested is causing the asthma. Also, the body's immune system produces an antibody to fight off the allergen. The amount of antibody can be measured by a blood test that will show how sensitive the patient is to a particular allergen. If the diagnosis is still in doubt, the patient can inhale a suspect allergen while using a spirometer to detect airway narrowing. Spirometry can also be repeated after a bout of exercise if exercise-induced asthma is a possibility. A chest x ray will help rule out other disorders.

Treatment

Once asthma is diagnosed, a treatment plan should be initiated as quickly as possible to manage asthma symptoms.

In most cases, asthma treatment is managed by the child's pediatrician. Referral to an asthma specialist should be considered if:

• There has been a life-threatening asthma attack or severe, persistent asthma.
• Treatment for three to six months has not met its goals.
• Some other condition, such as nasal polyps or chronic lung disease, complicates the asthma.
• Special tests, such as allergy skin testing or an allergen challenge, are needed.
• Intensive steroid therapy has been necessary.

The first step in bringing asthma under control is to reduce or avoid exposure to known allergens or triggers as much as possible. Treatment goals for all patients with asthma are to prevent troublesome symptoms, maintain lung function as close to normal as possible, avoid emergency room visits or hospitalizations, allow participation in normal activities—including exercise and those requiring exertion—and improve the quality of life.