Is asthma diagnosis difficult?

There is no one test that definitively proves asthma is present. Asthma diagnosis is determined by a combination of symptom observance, lung function tests and additional checks that can rule out other pulmonary diseases and by process of elimination zero in on asthma as the condition being presented.

Asthma Symptom Indicators

Asthma symptoms are similar to some other lung diseases, however the classic indicators that point to possible diagnosis include:  

·        Chronic coughing. This is often the first visible sign in children but can also be the most obvious one in adult asthma. Coughing occurs frequently, regardless of the presence of any other viral infection such as cold or flu.

·        Wheezing. This is a whistling sound indicating obstruction in the airways of the lungs.

·        Difficulty breathing. Asthma often makes it difficult to catch your breath. During an asthma attack this is obvious. With a chronic asthma condition it may be less obvious because the patient forgets what it is like to breath without any difficulty.

·        Tightness in the chest. Asthma makes it hard to breath in and out – it feels like nothing can move inside your chest.

·        Fatigue. Struggling to breath takes a huge amount of energy. Additionally, during an asthma event the body is not getting the full amount of oxygen it needs (because the air can’t get through the lung’s airways at the correct volume). Reduced oxygen levels create fatigue.

·        Runny nose/Itchy throat. These are symptoms of asthma only in that they are common indicators of allergies, which are often associated with asthma. A runny nose and itchy throat is seldom an indicator of an asthma condition if they are the only symptoms. There will be other lung symptoms as well.

Any of these symptoms are reason enough to seek medical attention. If asthma is the cause, it is important to get a diagnosis as quickly as possible so a management plan can be developed and the disease controlled.

Medical History Questions

If your caregiver suspects asthma, the first step in diagnosis is always a series of questions to try and narrow things down. You’ll be asked about the kind of symptoms you experience, when you experience them, if they seem to be connected to a place, or time, or activity etc.

Other questions that will most likely come up will be how often you get sick, how long you stay sick and whether or not colds seem to go right to your chest. Your caregiver will also be interested in any family history of asthma and whether or not you have tried any medication to improve your lung condition.

And of course, the doctor will listen to your chest with a stethoscope. This cannot determine whether or not asthma is present. But it is possible to ascertain whether the lungs are clear, or whether there is obstruction in the airways.

Spirometry

If asthma has not been ruled out, based on observed symptoms and the medical history provided through interview, the next step in the diagnosis will normally be a spirometry test.

By using a spirometer (a machine the patient blows into), the doctor can measure the volume of air that the lungs can inhale and the speed at which the patient can exhale. The results are then compared to a normal lung capacity. If they are lower, it is a good indication that the airways are narrowed for some reason.

This in itself isn’t necessarily an indication that asthma is present. All it indicates is that lung function is lower than it should be. However, once the test is done, the patient is often given some quick acting reliever asthma medication (normally a broncho dilator administered through a nebulizer mask).

The spirometry test is then repeated. If the results improve, the chances are pretty good asthma is present. If there were no change in the results it would indicate the condition was something that did not respond to asthma treatment and the doctors would investigate that possibility.

Often, the spirometry test will be enough for your caregiver to conclude that asthma is present. However, if the results are not conclusive, there are other tests that can be applied.

NOTE: Spirometry is not considered accurate with children under the age of 5 because the results depend on the cooperation of the patient in blowing out as hard and as long as possible. For younger children, doctors may decide to treat for asthma without further testing and monitor symptoms. If there is improvement, it is asthma – if not, further testing, looking for other conditions will be conducted.

Bronchial Challenge Test

If spirometry does prove inconclusive, a common strategy at this point is to try and actually induce a mild asthma condition. Using a bronchial challenge test, methacholine is administered by spray into the airways. This substance will irritate the bronchiole linings of any lung, however in asthmatics the inflammation is much quicker and more sensitive.

Once the methacholine is inhaled, spirometry is then used to measure lung function. If the results show significant decrease in lung function, asthma could be the culprit. 

This test should not be a cause of apprehension for patients - the dose of methacholine used is extremely small and only causes mild asthma symptoms. In addition, medication is available immediately to counter those symptoms if required. 

Testing for Exercise Induced Asthma

Another option caregivers may opt for is to try and induce asthma conditions through exercise. This is especially useful on younger patients. In mild forms of asthma, attacks are sometimes only brought on by exercise. Having a patient engage in moderate physical activity for as little as six minutes while monitoring lung capacity (with spirometry before and after) can often indicate exercise induced asthma.

Other Tests

In addition to the above tests, your caregiver may also recommend allergy testing, tests for gastroesophagal reflux disease (GERD) and possibly sinus disease. This is because these conditions are often associated with asthma.

It may also be decided to order chest x-rays or an electrocardiogram. These will not show asthma but they are useful in ruling out some other diseases that have asthma like symptoms.

A correct diagnosis is important because the treatments are different than those of other diseases that present asthma like symptoms.

Asthma Descriptions

If asthma is diagnosed, it is generally categorized into one of four descriptions. This is important, because it will determine the kind of treatment program recommended. These catagories are based on symptom frequency and severity:

·        Mild Intermittent: asthma symptoms twice a week or less, and night- time symptoms no more than twice a month.

·        Mild Persistent Asthma: asthma symptoms more than twice a week, but no more than once a day.  Night- time symptoms more than twice a month. Asthma symptoms may affect your activity levels.

·        Moderate Persistent Asthma: asthma symptoms every day, night- time symptoms more than once a week.  Asthma attacks may affect your activity levels.

·        Severe Persistent Asthma: asthma symptoms throughout the day on most days, night-time symptoms often.  Physical activity levels likely to be limited.

It must be noted that these descriptions are general. It is certainly possible for an asthmatic with mild intermittent asthma to suffer an acute attack.

Because there is no definitive test in asthma diagnosis, it may take some time before enough indicators are collected that your caregiver can conclude asthma is present. However, once this has been determined, it is then possible to work towards designing an action plan and getting control of the disease. And the earlier this is done, the earlier the patient will see relief.

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