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Asthma — The Path to Diagnosis

Posted on October 23, 2020

Article written by
Alison Channon

Asthma is a chronic lung condition that causes periodic or persistent breathing problems. It is caused by airway inflammation. Asthma is diagnosed by taking a medical history and conducting various lung function tests.

A person may start on the path to an asthma diagnosis because they are experiencing general symptoms associated with asthma. These symptoms include:

  • Shortness of breath
  • Chest tightness
  • Cough, especially at night
  • Wheezing

Children with asthma may exhibit the above symptoms as well. Some other symptoms to watch out for in children include:

  • Coughing during sleep
  • Repeated instances of bronchitis or pneumonia
  • Coughing or wheezing as the result of laughing, crying, or playing
  • Loud or fast breathing

Learn more about symptoms of asthma.

Who Gets Asthma?

Asthma typically begins in childhood, but it can also develop in adulthood. Asthma is fairly common in the United States. Nearly 25 million Americans had asthma in 2018, including approximately 5.5 million children, according to the Centers for Disease Control and Prevention. Globally, approximately 339 million people have asthma.

In the United States, more women than men have asthma — 12.6 million women compared to 6.7 million men. However, among children, more boys than girls have asthma — 3.1 million compared to 2.4 million.

Race, ethnicity, and socioeconomic status influence the diagnosis and management of asthma in the U.S. Compared to white Americans, Black Americans are 1.5 times as likely to have asthma, and Puerto Rican Americans are twice as likely to have asthma. Black Americans are five times as likely to visit the emergency room for asthma.

The Asthma and Allergy Foundation of America has identified several factors that contribute to racial, ethnic, and economic disparities in asthma health outcomes, including lack of access to health care and exposure to air pollution.

Read more about causes of asthma.

Diagnosing Asthma

Many people start the asthma diagnosis journey with their primary care provider or with their pediatrician during childhood. An official diagnosis may require seeing specialists, such as a pulmonologist (lung specialist) or an allergist.

A definitive asthma diagnosis requires the presence of respiratory symptoms consistent with asthma and test results demonstrating variable airflow obstruction. This means there are limits to your breathing capacity that vary based on asthma triggers.

Medical History and Physical Exam

Talking to your doctor or your child’s pediatrician is the first step to diagnosing asthma. Your doctor will ask you questions about your symptoms, your medical history, family medical history, and any risk factors for asthma.

Some risk factors for asthma include family history of asthma, having eczema, and being exposed to cigarette smoke and air pollution.

After taking a medical history, your health care provider may examine your nose, throat, and ears and listen to your breathing. They may also examine your skin for eczema or symptoms of an allergic reaction.

Pulmonary Function Tests

Pulmonary function, or lung function, tests help diagnose asthma and other respiratory diseases. The tests below are commonly used to diagnose asthma.

Spirometry

Spirometry is the primary test used to diagnose asthma in adults and children over the age of 5. This test assesses airway obstruction. The test is performed by breathing into a tube attached to a spirometer to measure how much air you can exhale and how quickly you can exhale. The test is then performed again after inhaling a fast-acting bronchodilator. A bronchodilator is a medication that expands the airways.

Exhaled Nitric Oxide Test

An exhaled nitric oxide test detects inflammation in the airways. High levels of nitric oxide, a gas produced by the lungs, can indicate the airways are inflamed — a potential sign of asthma. The test is performed by breathing into a machine that measures nitric oxide levels.

Challenge Tests

Challenge tests may be used when spirometry tests don’t show definitive results. They are often performed by an asthma specialist to ensure safety. A challenge test is performed by triggering asthma symptoms. This can be done by administering a substance that causes symptoms or performing physical activity to trigger symptoms. Lung function tests are performed before and after asthma symptoms are triggered.

You will always be given medication to stop symptoms once the challenge is complete. Safety is an important consideration when performing challenge tests. You will not be given a challenge test if you have health conditions that make it unsafe, such as uncontrolled high blood pressure or a recent heart attack or stroke, or if you are pregnant.

Diagnosing Asthma in Young Children

Pulmonary function tests used to diagnose asthma are difficult to perform in children age 5 and under. For young children, doctors generally rely on parental reports of symptoms. Keeping detailed notes of your child’s symptoms in advance of an appointment can help you discuss your concerns with their pediatrician. Asking other caregivers to take notes of breathing difficulties may also be beneficial.

Depending on the severity of a child’s symptoms, a doctor may prescribe an asthma treatment like an inhaler to see how a child responds. A doctor may also recommend allergy testing if asthma symptoms seem to be linked to allergic reactions.

Possible Diagnoses

There are several different types of asthma. You may receive a diagnosis based on the severity of your asthma:

  • Intermittent asthma
  • Mild persistent asthma
  • Moderate persistent asthma
  • Severe persistent asthma or severe asthma

You may also be given a diagnosis based on what causes your asthma, including:

  • Exercise-induced bronchoconstriction (exercise-induced asthma)
  • Allergic asthma (asthma induced by allergens, such as pollen or dust mites)
  • Occupational asthma (asthma caused by inhaling chemicals at work)

Learn more about the types of asthma.

After being diagnosed with asthma, your doctor will help you determine the best ways to treat your asthma. Possible treatments include inhaled corticosteroids or oral medications. Parents of a newly diagnosed child may wish to develop an action plan in the event of an asthma attack or exacerbation.

Ruling Out Other Conditions

Ruling out other conditions is important for an accurate diagnosis because many symptoms of asthma can be caused by other health problems. Your doctor may consider the possibility of the following health conditions when diagnosing asthma:

  • Chronic obstructive pulmonary disease (COPD)
  • Respiratory infections
  • Chronic rhinosinusitis (sinus infections)
  • Vocal cord dysfunction
  • Panic attacks
  • Airflow obstruction due to a benign or malignant tumor

A doctor may order blood tests, allergy tests, or computerized tomography (CT) scans of the chest or sinuses to rule out other conditions.

Learn more about conditions related to asthma.

Condition Guide

References

  1. Asthma — Centers for Disease Control and Prevention
  2. Asthma Facts and Figures — Asthma and Allergy Foundation of America
  3. Asthma: Testing & Diagnosis — Cleveland Clinic
  4. Asthma Symptoms — American Lung Association
  5. Childhood asthma — Mayo Clinic
  6. Asthma: Steps in testing and diagnosis — Mayo Clinic
  7. Asthma — National Heart, Lung, and Blood Institute
  8. Most Recent National Asthma Data — Centers for Disease Control and Prevention
  9. Asthma — World Health Organization
  10. Asthma Disparities in America — Asthma and Allergy Foundation of America
  11. Asthma Disparities in America: A Roadmap to Reducing Burden on Racial and Ethnic Minorities — Asthma and Allergy Foundation of America
  12. Diagnosis of asthma in adults — Canadian Medical Association Journal
  13. Conditions Related to Eczema — National Eczema Association
  14. Asthma Diagnosis — Asthma and Allergy Foundation of America
  15. How Is Asthma Diagnosed? — American Lung Association
  16. Allergens and Allergic Asthma — Asthma and Allergy Foundation of America
  17. Occupational Asthma — Mayo Clinic

Alison has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her here.

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