Asthma Part 2: The Medical Consult

In this part of the series, we will discuss on the diagnostic methods available.

Asthma is diagnosed in the primary care setting by a comprehensive medical history, family history, a physical examination and lung function tests.

Your primary care physician will determine the severity of your asthma which in turn will affect the treatment you require.

Referral to a Respiratory Specialist in the following situations:

  • Subspecialized tests are needed to confirm the diagnosis of asthma
  • There is a history of a life threatening asthma attack
  • Treatment for specific allergies
  • Polypharmacy (Multiple medicines) is needed to control your asthma

Important Points To Mention During Your Medical Consult

Important points to bring up during your medical consult include:

  • A Family history of asthma and allergies
  • Frequency of asthmatic attacks
  • Timing of asthmatic attacks, especially if it occurs only during certain times of the year, day, or in certain places.
  • Triggers of asthma specific to you
  • Related conditions when experiencing an asthmatic attack, like a concurrent upper respiratory tract infection, reflux disease, stress, sleep apnoea etc

Physical Examination

Physical examination would include:

  • Auscultation by your primary physician to listen for wheezing in the lungs
  • Examination of the upper airways, sinuses and upper nasal passages for existing upper airway diseases
  • Examination for other signs of allergic conditions eg eczema

Diagnostic Tests For Asthma

Lung Function Tests

Lung Spirometry is a type of Lung Function Test that measures the amount of air you inhale and exhale and the speed there.

Some respiratory specialists will use medicines to "treat" existing asthma and repeat the lung function tests again to see if there is any improvement. This is usually done if chronic asthma is suspected. It is also done when the diagnosis of asthma is unclear.

Associated Tests For Asthma

Other tests performed by respiratory specialists may include:

  • Allergy testing
  • Perform Bronchoprovocation tests to "trigger" a controlled asthmatic attack.
  • Chest X-Rays
  • Electrocardiograms (ECGs).

Asthma In Young Children

Many children develop asthmatic symptoms before 5 years of age and it is difficult to diagnoseose asthma in young children because the symptoms often present together with many other childhood diseases.

Reason is because children have small airways to begin with. Any respiratory condition with mucus production, for example, will further narrow their airways causing wheezing to be audible, thereby mimicking asthma. As the child grows older, the airways enlarge, and wheezing no longer becomes audible.

However, asthma should be suspected if:

  • One or both parents have asthma
  • Other allergic conditions eg eczema is present
  • A history of pollen allergy or hay fever is present
  • Wheezing is audible even when the child is healthy

In the following article, we will look at the challenges facing special population groups such as young children, pregnant women and elderly etc.