Introduction:
Asthma is a chronic lung disease affecting adults and children. In this condition, the airways become narrow and constricted due to the inflammation of the muscles around them. Common asthma symptoms include wheezing, cough, and shortness of breath. The symptoms appear intermittently and are worsened at night and during workouts. Often exacerbations are associated with a triggering factor, which varies from patient to patient. Common triggering factors include dust, viral infections, fumes, smoke, weather changes, animal fur, grass/tree pollen, the scent from strong soaps and perfumes, etc.
An early and appropriate asthma diagnosis is mandatory for implementing a proper treatment plan to help control the symptoms. Underdiagnosis often leads to under-treatment, which in turn leads to greater morbidity. Such patients will have sleep disturbances, malaise, and poor concentration leading to decreased productivity and creating a negative financial and social impact.
How is a Case of Asthma Diagnosed?
The diagnosis of asthma is based on exposure, family history, medical history, a complete physical examination, and medical tests like pulmonary function tests(spirometry).
The physician evaluates the symptoms presented and takes a proper health history which includes
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People with asthma in the family.
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Habits like smoking or exposure to smoke from someone else (passive smoking).
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Allergy.
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Exposure to polluting agents in the workplace might cause occupational asthma.
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Chest tightness or shortness of breath during workouts or exertion.
After a good medical history, tests are performed on the patient. The most common pulmonary function test is spirometry, which uses a spirometer. The spirometer measures the speed and volume of air blown out of the lungs, thus helping to find the lungs' functioning.
The other tests are allergy tests (using blood or skin sample), blood tests to evaluate the presence of inflammatory cells, FeNo tests (measures the exhaled nitric oxide), and challenge tests.
What Are the Different Tests to Examine Lung Function?
Spirometry:
A pulmonary function test measures the volume and speed of air a person blows out. The physician will ask the person to take a deep breath and blow out with maximum capacity into a tube linked to a small spirometer machine. Asthmatic patients will have difficulty breathing in or inhaling a good amount of air because of their narrow, constricted airways. The healthcare provider will provide the patient with a medicine that will assist in inhaling and then blow out the air into the tube. A comparison is made between the test results with and without taking medicine. Some patients might feel tiredness or lightheadedness from the effort of breathing.
Spirometry with Bronchodilators:
Initially, the normal spirometry test is performed on the patient without giving any medication then the patient is given a bronchodilator to inhale; this will relax and open up the airways. The spirometry test is performed again, and the test results are compared. A comparison is made between the volume and speed of air exhaled before and after administering a bronchodilator.
Bronchoprovocation Tests:
As the name suggests, this test involves provoking the airways with certain substances and assessing the response. It measures how the airways react when certain substances in the air are inhaled. In this test, the patient will breathe in allergic substances or medications that tighten the muscles surrounding the airway. The volume and speed of the air are measured before and after.
Peak Expiratory flow (PEF) Tests:
The peak expiratory flow test will measure how fast a patient can blow out air using maximum effort. Often this test is performed along with a spirometry test or using a small handheld device.
Fractional Exhaled Nitric Oxide (FeNO) tests:
Fractional exhaled nitric oxide tests will measure the amount of nitric oxide in the breath. A high nitric oxide concentration in the exhaled air indicates an inflammatory airway, making breathing difficult. In the test, the air is exhaled into a tube connected to a portable device. This test does not involve any risk and does not require heavy breathing, and steady breathing is enough.
The test is performed on children above five years of age and adults.
Allergy Tests:
An allergy test determines the agent that will cause an allergic reaction in a patient's body when exposed to the substances. The allergens include pet fur and feathers, tree or grass pollen, etc.
How to Diagnose Asthma in Children?
Performing tests in children below the age of six years is rather difficult because of their uncooperative nature. Taking a good history will help in identifying the condition to some extent. A child is likely to have asthma in the following situations:
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Any one of the parents is asthmatic
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If the child has allergic conditions like eczema (a condition that causes the skin to become rough, itchy, and cracked).
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Constant exposure to tobacco smoke throughout childhood or during pregnancy.
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Exposure to outdoor and indoor pollutants.
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If the child is wheezing in viral respiratory infections like cold.
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Obese children.
The parent should be highly cooperative and provide all the necessary information that the health care provider asks to make a correct diagnosis of asthma. They should provide accurate information about family history, asthma or allergy, breathing patterns, and the child's behavior. In adults, as discussed above, lung function tests are performed to diagnose asthma; however, they are really difficult to perform on young children. The physician uses a four to six-week asthma medication as a trial to see for any difference in symptoms, and based on this, the diagnosis of asthma is confirmed in young children.
Conclusion
Asthma is a chronic lung disease, and failure to diagnose the disease will result in undertreatment. Under-treated cases of asthma result in serious morbidities and increased mortality rates. With a proper diagnosis, the physician will evaluate a treatment plan for the patient based on their condition's severity and symptoms. The treatment plan varies for each individual and is determined by the healthcare provider after a proper evaluation. Though it is impossible to cure asthma completely, we can control the symptoms with good management and proper medications, which is possible if the diagnosis is right.
