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DIAGNOSIS OF ASTHMA

An allergist will ask you questions about your symptoms, personal and family medical history. The doctor will also perform a physical examination: they will focus on the upper respiratory tract, chest, and skin. They will look for signs of wheezing, which may indicate an obstructed airway and asthma, and check the skin for signs of eczema or hives.

Your doctor will identify if your asthma is mild intermittent, mild persistent, moderate persistent, or severe persistent. They will also identify its type.

The following tests can help diagnose asthma:

Pulmonary function tests: These tests determine how much air moves in and out while breathing.

  • Spirometry: At the beginning of the test, you should breathe deeply into your mouth, into the spirometer. Then you will have to blow hard on the spirometer, the procedure is repeated at least 3 times. This test diagnoses the severity of asthma and measures how well the treatment is working. However, this test may not be suitable for children under the age of 5, as it is difficult to get an accurate result. Instead, your doctor may prescribe asthma medication for 4-6 weeks and check if the symptoms improve.
  • Peak expiratory flow: A peak flow meter is a simple device that measures the maximum flow of air that is expelled from the lungs during a forced exhalation.

Pulmonary function tests are performed before and after the administration of a bronchodilator that helps open the airways. If your lung function improves, you may have asthma.

Additional tests

Other tests to diagnose asthma are:

  • Methacholine challenge: Methacholine is a known trigger of asthma. When inhaled, the airways will narrow slightly. If you react to methacholine, you may have asthma.
  • Imaging tests: A chest X-ray can help identify any structural abnormalities or diseases that may cause or worsen breathing problems.
  • Allergic tests: May be performed on the skin or by a blood test. Indicates if you are allergic to pets, dust, mold, or pollen.
  • Measurement of FeNO (fractional nitric oxide in exhaled air): This test measures the amount of nitric oxide in your breath. When the airways are inflamed, you may have higher than normal levels of nitric oxide.
  • Sputum examination: This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus eliminated during coughing. Eosinophils are present when symptoms develop and become visible when stained with a pink dye.
  • Challenge test: This test allows the doctor to assess how cold air or exercise affects breathing.

CLASSIFICATION OF ASTHMA

To classify the severity of asthma, your doctor will consider how often you have symptoms, how severe they are, the results of the physical exam, and the diagnostic tests. Determining the severity of asthma will help the doctor choose the best treatment. The severity of asthma often changes over time and treatment needs to be adjusted.

Asthma is classified into four general categories:

  • Mild intermittent: Mild symptoms occur two days a week or two nights a month.
  • Mild persistent: Symptoms appear more than twice a week and up to four nights a month.
  • Moderate persistent: Symptoms occur once a day and more than one night a week. These may limit certain daily activities.
  • Severe persistent: Symptoms occur several times each day and most nights. Daily activities are extremely limited.

TREATMENT FOR ASTHMA

Medicines

The right medicines for you depend on several things: age, symptoms, and the factors that trigger asthma.

  • Long-term medicines

These medicines, administered daily, help reduce the number and severity of asthma symptoms, and prevent an asthma attack.

Long-term medicines include the following:

  1. Inhaled corticosteroids: If they are taken with an inhaler, corticosteroids and other anti-inflammatory medicines help reduce swelling and mucus production in the airways, making breathing easier. These medicines need to be used for a few days or weeks to be effective. Unlike oral corticosteroids, inhaled corticosteroids have a relatively low risk of serious side effects.
  2. Anticholinergics: Help muscles not to tighten around the airways. They are usually given daily in combination with anti-inflammatory medicines.
  3. Long-acting bronchodilators: They are administered only in combination with anti-inflammatory medicines.
  4. Biological medicines: These injectables can help people with severe asthma.
  • Fast-acting sedatives

These medicines should only be used during an asthma attack. They provide quick relief to help you breathe again. They can also be used before exercise if your doctor recommends it.

Fast-acting sedatives include the following:

  1. Short-acting beta-blockers: Fast-acting bronchodilators work in minutes to quickly reduce the symptoms during an asthma attack. They are inhaled through a face mask or mouthpiece.
  2. Anticholinergic agents: They act quickly to relax the airways, making breathing easier. They are usually given in combination with anti-inflammatory medicines.
  3. Oral and intravenous corticosteroids: They relieve the airway inflammation caused by severe asthma. They can cause serious side effects if used long-term.
  • Medicines for allergies

They can help you if your asthma is triggered or aggravated by allergies.

These include:

  1. Allergy injections: If your asthma is triggered by an allergy, you should consider allergy injections which are very effective in relieving allergy symptoms and in some cases can even cure the allergy. It works by injecting very small amounts of allergen at first and then gradually increasing until it reaches a constant dose. Generally, the injection is given once a week for several months, then once a month for a period of three to five years.
  2. Sublingual tablets: Only a few allergens can be treated at this time with this method. These medicines should not be used in patients with severe or uncontrolled asthma. Starting a few months before the start of the allergy season, patients take one tablet daily. Treatment can continue for up to three years.

Bronchial thermoplasty

This treatment uses an electrode to warm the airways, helping to reduce the size of the muscle and prevent it from tightening. It is used for severe asthma that does not improve with long-term medicines. Therapy is usually done during three visits.

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