How Is Asthma Diagnosed?
Some things your doctor will ask about include:
- Periods of coughing, wheezing, shortness of breath, or chest tightness that come on suddenly or occur often or seem to happen during certain times of year or season
- Colds that seem to "go to the chest" or take more than 10 days to get over
- Medicines you may have used to help your breathing
- Your family history of asthma and allergies
- What things seem to cause asthma symptoms or make them worse.
Your doctor will listen to your breathing and look for signs of asthma or allergies.
Your doctor will probably use a device called a spirometer (speh-ROM-et-er) to check your airways. This test is called spirometry (speh-ROM-eh-tree). The test measures how much air and how fast you can blow air out of your lungs after taking a deep breath. The results will be lower than normal if your airways are inflamed and narrowed, as in asthma, or if the muscles around your airways have tightened up. As part of the test, your doctor may give you a medication that helps open up narrowed airways to see if it changes or improves your test results. Spirometry is also used to check your asthma over time to see how you are doing.
If your spirometry results are normal but you have asthma symptoms, your doctor will probably want you to have other tests to see what else could be causing your symptoms. One test commonly used is a bronchial challenge test. A substance such as methacholine, which causes narrowing of the airways in asthma, is inhaled. The effect is measured by spirometry. Children under age 5 usually cannot use a spirometer successfully. If spirometry cannot be used, the doctor may decide to try medication for a while to see if the child's symptoms get better.
Besides spirometry, your doctor may also recommend that you have:
- Allergy testing to find out if and what allergens affect you
- A test that uses a hand-held peak flow meter every day for 1-2 weeks to check your breathing (a peak flow meter is a device that shows how well you are breathing)
- A test to see how your airways react to exercise
- Tests to see if you have gastroesophageal reflux disease (GERD)
- Test to see if you have sinus disease.
Other tests, such as a chest x-ray or an electrocardiogram, may be needed to find out if a foreign object, or other lung diseases or heart disease could be causing asthma symptoms. A correct diagnosis is important because asthma is treated differently from other diseases with similar symptoms.
Depending on the results of your physical exam, medical history, and lung function tests, your doctor can determine how severe your asthma is. This is important because your asthma severity will determine how your asthma should be treated. A general way to classify severity is to consider how often a person has symptoms when that person is not taking any medicine or when his or her asthma is not well controlled. Based on symptoms, the four levels of asthma severity classification are:
- Mild Intermittent (comes and goes)--when your asthma is not well controlled, you have asthma symptoms less than twice a week, and you are bothered by symptoms at night twice a month or less.
- Mild persistent asthma--when your asthma is not well controlled, you have asthma symptoms more than twice a week, but no more than once in a single day. You are bothered by symptoms at night more than twice a month. You may have asthma attacks that affect your activity.
- Moderate persistent asthma--when your asthma is not well controlled, you have asthma symptoms every day, and you are bothered by nighttime symptoms more than once a week. Asthma attacks may affect your activity.
- Severe persistent asthma--when your asthma is not well controlled, you have symptoms throughout the day on most days, and you are bothered by nighttime symptoms often. In severe asthma, your physical activity is likely to be limited.
Anyone with asthma can have a severe attack-even those who have intermittent or mild persistent asthma.
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