Asthma Diagnosis and Treatment

Types of Asthma

These are the most common forms of asthma:

• Childhood asthma: Typically develops in infants and young children and often improves with age. However, in some instances, it may persist into adulthood.
• Exercise-induced asthma: Triggered by intense physical exertion or extended activity. Adjusting exercise type and surroundings—such as running indoors in winter and not outside in the cold—may help alleviate symptoms.
• Occupational asthma: Results from workplace irritants like dust and air pollution. Symptoms may lessen or disappear if the work setting is modified.
• Allergy-induced asthma: Individuals sensitive to pollen, pet dander, or smoke can reduce the likelihood of asthma attacks by limiting exposure to these allergens.

Symptoms

Common symptoms of asthma include:

• Coughing: Usually, a dry cough that worsens due to asthma triggers such as cold air, allergens, or physical activity.
• Wheezing: A high-pitched whistling noise when breathing caused by air passing through restricted air paths in the lungs.
• Breathlessness: Shortness of breath, struggling to get sufficient air, or breathing more rapidly and forcefully than usual.
• Chest tightness: Some individuals experience a tight sensation, dull ache, or even sharp pain in the chest.

Asthma-related symptoms can vary from mild to severe, differing among individuals and even at different periods for the same person. Episodes may last an hour or continue for days or weeks if not treated.

Mild untreated asthma symptoms:

Mild symptoms of asthma may appear occasionally, such as a slight wheeze or a cough triggered by a cold or chest infection. Symptoms might also emerge in hay fever season or after physical activity.

In most cases, there may be no symptoms at all. A kid with mild asthma might experience a persistent nighttime cough but generally feels fine throughout the day.

Moderate untreated asthma symptoms:

Wheezing and coughing episodes occur periodically, sometimes accompanied by breathlessness. There are usually symptom-free periods, but wheezing is present on most days.

Symptoms often worsen at night or early in the morning, potentially causing nighttime wakening due to coughing or chest tightness. Symptoms may not always be typical in young children, making it challenging to distinguish asthma from repeated chest infections.

Severe asthma attack symptoms:

A severe asthma attack results in intense chest tightness, wheezing, and breathing difficulties. Speaking may also become difficult due to extreme breathlessness.

Individuals experiencing a severe attack typically look and feel significantly unwell. Emergency medical care is essential in such cases. Intense symptoms can arise suddenly, even in those who normally experience only mild to moderate asthma.

Causes

Asthma symptoms result from inflammation or swelling in the lung airways, which can be prompted by different factors in different individuals. This inflammation triggers the muscles near the airways to contract (tighten). As a result, it becomes harder for air to flow in and out of the lungs, causing breathlessness and wheezing. Additionally, the inflamed air passage lining produces excess mucus, leading to coughing and further restricting airflow.

Risk factors that may be linked to asthma include:

• Family history of allergic conditions
• Individual history of hay fever (allergic rhinitis)
• Childhood viral respiratory infections, like respiratory syncytial virus (RSV)
• Cigarette smoke exposure
• Obesity
• Reduced socioeconomic status
• Air pollution or burning biomass exposure

Common Triggers of an Asthma Attack:

Some factors can provoke asthma attacks in individuals at high risk. For this reason, identifying and keeping off these triggers can help reduce flare-ups. The common triggers involve:

• Physical exertion or exercise
• Allergens like pollen, pet dander, dust mites, or mould
• Cold, dry air
• Respiratory infections like flu or a cold
• Environmental pollutants, including smoke or car exhaust
• Emotional stress
• Certain medications like beta-blockers, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs)
• Acid reflux or heartburn
• Food or wine additives like sulphites
• Hormonal fluctuations, including menstrual cycles

Diagnosis

Diagnosing asthma starts with a thorough medical history and physical exam. While primary-care providers can diagnose asthma, specialists like allergists or pulmonologists may also be involved. Typically, persons with a family history of allergic disorders or personal allergic rhinitis experience symptoms like wheezing, coughing, and breathing difficulties, particularly with workouts, viral infections, or nighttime. A positive response to asthma medications strongly suggests the condition.

Diagnostic procedures for asthma:

• Lung function testing (spirometry): This test evaluates lung function by measuring airflow as you breathe into a tube. A significant improvement after using a bronchodilator like salbutamol confirms asthma. However, normal spirometry results do not entirely rule out the condition.
• Exhaled nitric oxide (FeNO) measurement: This simple breathing test detects high nitric oxide levels. The heightened levels indicate T2 inflammation associated with certain asthma types.
• Skin testing for aeroallergens: Identifying allergies to environmental allergens can raise the possibility of asthma. Unlike blood tests for detecting environmental sensitivities, skin testing is generally more reliable. However, food allergy testing is not usually required to diagnose asthma.
• Blood tests: These may be used to check for allergic antibodies (IgE) as well as eosinophils to help identify T2-high asthma.

Other less common tests are:

• Provocation testing (methacholine challenge): This test assesses airway hyperresponsiveness, a hallmark of asthma. A negative result makes asthma unlikely.
• Sputum eosinophil measurement: Occasionally used by specialists to detect allergic inflammation in asthma.
• Imaging tests (chest X-ray or CT scan): These may show lung hyperinflation, although they are mostly normal for asthma.
• Additional testing: In some cases, cardiac evaluations or other tests may be needed to rule out conditions that mimic asthma.

Classifications of Asthma

Asthma varies in severity, with some cases being mild and requiring little to no treatment, while others can be serious and fatal. Healthcare professionals classify asthma into four levels based on symptom frequency, severity, and response to treatment.

• Mild intermittent asthma: This is the most common type, with mild symptoms occurring no more than twice a week and nighttime symptoms no more than twice a month.
• Mild persistent asthma: Symptoms remain mild but occur more than twice a week, though not more than once per day.
• Moderate persistent asthma: Symptoms appear daily or on most days, with nighttime symptoms occurring at least once per week.
• Severe persistent asthma: Symptoms occur multiple times throughout the day and frequently at night. This type is less responsive to medications, even when taken consistently.

Asthma Treatment and Management

Although asthma cannot be completely cured, it can be managed to reduce the severity and frequency of attacks.

The doctor will collaborate with you to develop a personalised action plan based on test results and diagnosis. Your plan will generally outline the following:

• Your asthma triggers—such as allergens, irritants, exercise, strong emotions, certain medicines, or cold air.
• Ways to avoid or minimise exposure to potential triggers.
• How to recognise an asthma attack and respond appropriately.
• Steps to take during an attack.
• Medications to use, including dosages and timing.
• When and how to look for emergency medical care.

Once your plan is in place, the doctor will schedule regular check-ups to ensure it’s working and make adjustments as needed.

Asthma medications:

These include:

• Allergy shots to gradually desensitise your body to triggers.
• Bronchial thermoplasty, a procedure that uses heat to shrink and relax lung muscles in order to asthma attacks.
• Corticosteroids or other anti-inflammatory medications (inhalers or pills) to ease airway swelling.
• Metered-dose inhalers that contain corticosteroids or bronchodilators to open airways and ease inflammation.
• Biologic therapies, which target antibodies to prevent the onset of inflammation and asthma symptoms.

Additional support:

Managing asthma goes beyond medication. For this reason, we provide resources to enable you to live well with this chronic illness, including:

• Nutritional guidance from dietitians to help maintain a healthy weight.
• Smoking cessation support to help you quit if you smoke.
• Mental health services to address stress-related asthma triggers.
• Vaccination updates to prevent infections that could worsen asthma symptoms.

Conclusion

While asthma can’t be cured, we can help you manage it so your breathing becomes easy and enables you to live more freely. Furthermore, we will teach you how to identify your asthma triggers and provide strategies to keep symptoms under control. Our goal is to help you stay active, enjoy your daily activities, and reduce the fear of unexpected attacks. With the right plan, you can take charge of your asthma—so it doesn’t take charge of you.

For more information or to address any concerns, book an appointment with us today.