As many as 17 million American adults have asthma. You may be interested to learn how a doctor identifies and treats this common inflammatory disease.

Coughing, wheezing, and shortness of breath: These may be the symptoms that first take a person to the doctor’s office. Several conditions may cause these symptoms. So, how does the doctor know when it’s asthma?

None of those symptoms alone would be enough to clinch the diagnosis of asthma. However, the level of suspicion rises when shortness of breath appears along with wheezing.

Another tip-off is the presence of chronic rhinitis—a persistent runny or congested nose, which plagues 80% of individuals with asthma. In 15% of people, cough is the only symptom.

A further clue to asthma is tiredness due to interrupted sleep. The person may not realize that in the middle of the night his or her sleep had been disturbed by bronchospasm (an episode of sudden narrowing of airways in the lungs).

Digging deeper

A childhood or family history of asthma helps put a person’s symptoms into context. The timing of symptoms is also a giveaway. For example, asthma is suspected if the person wheezes, coughs, or experiences shortness of breath

• after exercise
• at night
• following exposure to pollen or other allergens (substances that provoke an allergic reaction)
• after a sinus or other respiratory infection or a bout of acid reflux.

A physical exam will help establish an asthma diagnosis. A prolonged exhalation suggests that a person’s airway is obstructed, as does a whistling noise in the bronchial tubes. Besides listening to the person’s lungs, the doctor looks for other signs of allergic disease—such as blockages in the nose or an itchy inflammation on the skin (eczema), particularly on the forearm or neck (a sign of allergic asthma). The doctor might even suspect asthma based simply on the person’s posture: Most individuals with airway obstruction sit or stand very straight to achieve more lung capacity.

One procedure that can seal the asthma diagnosis is office spirometry, a pulmonary function test that measures how much air moves out of the lungs and how fast. The test is done before and after a person uses a bronchodilator medication to open the airways. If the drug improves lung function by 15% to 20%, then the person probably has at least a component of asthma as opposed to a different respiratory ailment.

The treatment plan

Once asthma has been identified, the chief goal of treatment is to control airway inflammation. Airway inflammation is the feature of asthma that affects quality of life and sends a person to the doctor, the emergency room, or into a hospital bed.

The first step in the treatment plan is to avoid the allergens that set off asthma flares. If pollen is to blame, staying indoors during high pollen periods may be the answer. If dust mites are the problem, then covering mattresses and pillows with protective covers is essential. If symptoms are triggered by cigarette smoke, paint fumes, or other environmental irritants, then the person needs to steer clear of those substances.

Symptom-stoppers

Medications to control inflammation are called controllers and relievers. Controllers keep inflammation in check. They include inhaled corticosteroids such as beclomethasone (for example, Qvar), long-acting beta-2 agonists such as salmeterol (available as Serevent), and leukotriene modifiers such as montelukast (sold under the name Singulair).

Relievers, which are rescue medications, provide quick relief during a flare-up of symptoms. Relievers include short-acting beta-2 agonists such as albuterol (available as Proventil) and oral corticosteroids such as prednisone.

More severe symptoms require more medication. Asthma is classified in 4 categories, based on symptom frequency and severity: mild intermittent, mild persistent, moderate persistent, and severe persistent. People with any degree of asthma should learn how to recognize the onset of symptoms so that they can take swift action and stop the flare-up before it gets worse.

From The American Journal of Medicine