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Symptoms, Diagnosis, Test of Asthma More

Symptoms, Diagnosis, Test of Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These episodes may occur a few times a day or a few times per week. Depending on the person, they may become worse at night or with exercise.

Asthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation [Rx]. The interaction of these features of asthma determines the clinical manifestations and severity of asthma [Rx] and the response to treatment.

Sign Symptoms of Asthma

Early warning signs of asthma include. Intermittent and variable (may also be absent, e.g., during symptom-free intervals or in mild disease)

Shortness of breath (often in acute episodes)
Expiratory wheezes
Chest pressure sensation
Cough
Frequent cough, especially at night
Losing your breath easily or shortness of breath
Feeling very tired or weak when exercising
Wheezing or coughing after exercise
Feeling tired, easily upset, grouchy, or moody
Decreases or changes in lung function as measured on a peak flow meter
Signs of a cold or allergies (sneezing, runny nose, cough, nasal congestion, sore throat, and headache)
Trouble sleeping

Common signs and symptoms of asthma include

Coughing – Coughing from asthma often is worse at night or early in the morning, making it hard to sleep.
Wheezing – Wheezing is a whistling or squeaky sound that occurs when you breathe.
Chest tightness – This may feel like something is squeezing or sitting on your chest.
Shortness of breath. Some people who have asthma say they can’t catch their breath or they feel out of breath. You may feel like you can’t get air out of your lungs.
Shortness of breath
Trouble sleeping caused by shortness of breath, coughing or wheezing
A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu
Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
Exercise-induced asthma, which may be worse when the air is cold and dry
Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust
Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pets (pet dander)

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Other symptoms of an asthma attack include

Severe wheezing when breathing both in and out
Coughing that won’t stop
Very rapid breathing
Chest pain or pressure
Tightened neck and chest muscles, called retractions
Difficulty talking
Feelings of anxiety or panic
Pale, sweaty face
Blue lips or fingernails

Diagnosis, Test of Asthma

Basic diagnostic evaluation of bronchial asthma

History

Sudden onset of symptoms, often at night or in the early morning hours, typically shortness of breath and cough (productive or unproductive), particularly
- after allergen exposure
- during (or, more commonly, after) physical exertion or sports (so-called
- exercise-induced asthma)
- in the setting of upper respiratory infection
- on exposure to thermal stimuli, e.g., cold air
- on exposure to smoke or dust
Seasonal variation of symptoms (seasonal elevation of pollen count)
Positive family history (allergy, asthma)
Precipitants of asthmatic symptoms in the patient’s environment at home, at work, and during leisure activities

Differential diagnosis

The following entities should be considered in the differential diagnosis of bronchial asthma because of their frequency and clinical significance (1, 3):

Chronic obstructive pulmonary disease (COPD)
Hyperventilation
Aspiration
Laryngeal changes/vocal cord dysfunction
Pneumothorax
Cystic fibrosis (CF)
Cardiac diseases, e.g., left heart failure
Pulmonary embolism
Gastroesophageal reflux disorder.

In as many as 10% to 20% of cases, a clear-cut distinction between asthma and COPD cannot be drawn.

Allergy test – Reasonable because many children show relevant sensitization even under 3 years of age. For example, sensitivity to house-dust mites is associated with increased asthma risk.
Lung function diagnostics – Children usually have to be 5–6 years old before spirometry is possible, but it can be attempted earlier with sufficient expertise and time investment. The GINA Guidelines do not make any reference to alternative technologies (forced oscillation, impulse oscillometry, multiple-breath washout etc.). In addition, these techniques currently are only available in specialized centers.
Exhaled NO – Listed as a possible examination (tidal technique) in the GINA Guidelines, but not yet established for young children (apart from scientific applications). As soon as spirometry is possible, the forced expiratory flow maneuver can usually be employed in a defined flow range (“single-breath” method).
Further tests – mainly to rule out differential diagnoses: In addition to the lung X‑ray specified in the GINA Guidelines, further examinations (bronchoscopy, sweat test, pH measurement etc.) may be required. However, they are not part of the primary diagnosis.

You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include:

Spirometry – This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
Peak flow – A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and deal with low peak flow readings.

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Additional tests of Asthma

Other tests to diagnose asthma include

Methacholine challenge – Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal.
Imaging tests – A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems.
Allergy testing – This can be performed by a skin test or blood test. Allergy tests can identify allergy to pets, dust, mold and pollen. If important allergy triggers are identified, this can lead to a recommendation for allergen immunotherapy.
Sputum eosinophils – This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you discharge during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye (eosin).
Provocative testing for exercise and cold-induced asthma – In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air.

Alternative medicine

Acupuncture is not recommended for the treatment as there is insufficient evidence to support its use. Air ionisers show no evidence that they improve asthma symptoms or benefit lung function; this applied equally to positive and negative ion generators.

Manual therapies, including osteopathic, chiropractic, physiotherapeutic and respiratory therapeutic maneuvers, have insufficient evidence to support their use in treating asthma. The Buteyko breathing technique for controlling hyperventilation may result in a reduction in medication use; however, the technique does not have any effect on lung function. Thus an expert panel felt that evidence was insufficient to support its use.

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The main adverse effects of anti-asthmatic medication

Inhaled short-acting beta2 sympathomimetic agents – Fine tremor of voluntary muscle; agitation; tachycardia; palpitations
Inhaled long-acting beta2 sympathomimetic agents (LABA) – Same adverse effects as short-acting agents; also: tolerance of bronchoprotective effect in the presence of bronchoconstricting stimuli (while the bronchodilating effect of the drug is maintained); to be used over the long term only in combination with glucocorticoids (usually ICS)
Inhaled corticosteroids (ICS) – oropharyngeal candidiasis (thrush); hoarsenessSystemic: depending on the dose and the duration of administration, osteoporosis; cataracts; glaucoma; delayed growth in childhood; suppression of adrenocortical function
Systemic corticosteroids – Cushing syndrome; osteoporosis; myopathy; glaucoma; cataracts; endocrine psychosyndrome; worsening of diabetes mellitus; sodium retention; hypertension; adrenocortical atrophy; elevated susceptibility to infection
Montelukast – Abdominal symptoms; a headache; unclear association with Churg-Strauss syndrome, thus the dose of simultaneously administered systemic glucocorticoids should be lowered cautiously
Theophyllin – Depending on the serum concentration: gastrointestinal disturbances; gastroesophageal reflux disorder; tachycardia; diuresis; agitation; insomnia When the serum concentration exceeds 25 mg/L: epileptic seizures; gastrointestinal bleeding; ventricular arrhythmia; hypotension
Omalizumab – Local reactions at the subcutaneous injection site; a headache

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