Although you can be diagnosed with asthma at just about any age, most people will find that they exhibit the signs and symptoms of the disease during childhood. Even though your physician is very familiar with the classic signs of wheezing, shortness of breath and coughing there are also other general nonspecific symptoms which may be the only symptoms present. These nonspecific symptoms can make the diagnosis difficult.
Diagnosis of the disease will include a thorough medical history, physical evaluation and additional medical testing. Some of the classic symptoms which may come out during a thorough medical history are shortness of breath, coughing and wheezing. The wheezing may be high-pitched whistling when they\’re breathing in or out and the cough characteristically dry and worse at night.
Typically symptoms will come and go over time and not be consistent. This is called episodic symptoms. The doctor will ask you to explain how quickly the symptoms come on and how you are able to relieve them. They may also ask you to think about specific things that trigger symptoms such as allergies, smoke, changes in the weather, upper respiratory infections or exercise.
There are actually two different types of asthma from which people can suffer, intrinsic and extrinsic asthma. Asthma symptoms may be triggered because of extrinsic factors such as allergens, smoke or chemicals. Other individuals find that their triggers are more intrinsic, such as exercise or upper respiratory infections.
During a physical examination your physician will listen to the lungs using a stethoscope. We will listen in all quadrants of the lungs on both sides of the chest and in the front and back. It is not uncommon for a person who suffers from asthma to wheeze only in one particular lung, in one particular area. Often times when the symptoms are mild individuals may not even recognize that they are wheezing. Wheezing is not an indication of how mild or severe the asthma is.
The physician will also listen to the heart, check for signs of poor oxygenation and nasal inflammation. Individuals who have a pale swelling of the nasal cavity may also suffer from allergic rhinitis which can worsen asthma symptoms.
While in the office the physician may ask the individual to do a peak expiratory flow rate which is a measurement of airflow in the lungs. Norms have been developed which take into account an individual\’s height, weight and age giving the physician a good idea of whether or not the peak expiratory flow is compromised in individual, even after the first test. Commonly the individual will go home with a peak expiratory flow rate meter in order to measure their rate at home and keep a record. This record will help you and your physician determine when treatment is necessary.
The doctor may also use a test called spirometry to check how the lungs are functioning. This test measures how much air an individual can breathe in and out as well as how fast air can be pushed out. The doctor may also give you medications and ask you to test again. If the starting results are lower than normal and improved with medication, and if the medical history shows a pattern of symptoms, the physician can diagnose you at this time with asthma.
If more information is needed to make a definitive diagnosis the physician may order a challenge test. This test is designed to cause the airway to narrow in children with asthma and is done in a specialized testing center that is capable of providing emergency care if needed. A specific medication is given to the individual to constrict the airway and increase slowly while the individual is tested. The test is considered positive if there\’s a 20% decline in results with any dose of medication.
Both the spirometry testing and the challenge testing are called lung function tests and are used to and hands the ability of the physician to make a definitive diagnosis as well as help the physician to measure current lung function of the child or adult.
The physician may also ask for a chest x-ray, sweat chloride test, barium swallow to look for gastroesophageal reflux or skin testing to look for allergies. Children less than four year are usually not able to perform peak expiratory flow rate testing.
Diagnosis of asthma is not one to be taken lightly and should be done by a qualified physician or pulmonologist. Without proper treatment long-term damage to both the lungs and heart are highly likely, but, with treatment this damage is significantly reduced.