Diagnosis of Asthma Part 1-By Dr.Karim
The diagnosis of bronchial asthma is based upon clinical diagnosis.
It is important during the diagnosis of asthma to keep its definition in mind It is a chronic inflammatory disorder of the airways in susceptible individuals, the inflammatory symptoms are usually associated with widespread but variable airflow obstruction and an increase in airway response to a variety of stimuli. The obstruction is often reversible either with or without treatment.
Remember Symptoms produced by asthma such as cough, wheeze and shortness of breath can be caused by other respiratory diseases as well, this also applies to signs produced by bronchial asthma such as rhonci.
How is a clinical diagnosis of asthma made ?
A Detailed history taking is the most important step for the diagnosis of bronchial asthma
What should the doctor ask about to diagnose asthma ?
-Are there any family members who suffer from asthma as well ? Remember that asthma has a genetic predisposition (it tends to run in families)
–Are there any other allergic disorders present? such as rhinitis, dermatitis or sinusitis
-Is there a day-night variation of symptoms? or Do symptoms become worse at night? Remember that bronchial asthma tends to be nocturnal
– Housing conditions if the patient lives in a well ventilated house or a damp house , if symptoms become worse when the patient is in his home or outside, if patient owns any pets.
-Do symptoms become worse after vacuuming the carpet or the bed ? Remember dust mites are the most common extrensic type of allergen.
-Does the patient complain of itching or red eye after handling pets ?
–Does the patient smoke ?
-Does certain drugs like aspirin and ibuprofen cause aggravation of symptoms of bronchial asthma ?
-Can laughing, crying, frustration or anger cause aggravation of symptoms of bronchial asthma ? Remember intrinsic causes of asthma
-Where does the patient live ? Remember pollution can cause aggravation of bronchial asthma.
-Where does the patient work ? Occupational asthma will be discussed in a later article.
– Is asthma aggravated by exercise ? Exercise induced asthma will be discussed in a later article.
-Do symptoms of bronchial asthma become worse during certain seasons ? Remember bronchial asthma may be worse during Spring due to exposure to pollen (extrensic factor) and it may be worse during winter due to exposure to cold ( intrinsic factor)
-Are there any other precipitating or aggravating factors ? such as viral respiratory tract infections, exposure to vapors, gases, aerosols
Determining the severity of asthma is very important to determine the perfect line of treatment.
In Intermittent asthma,
The symptoms of asthma ( as cough and wheezes) occur 2 or less days per week
Patient awakens from sleep with symptoms of asthma 2 times or less per month
The asthma doesn’t interfere with is normal daily activity
In Mild persistent asthma,
Symptoms occur more than 2 days per week
Patient awakens 3-4 times per month
There is minor limitation of his normal activity
While in Moderate persistent asthma,
Symptoms occur daily
Patient awaken more than once per week with asthma symptoms but not every night
There is some limitation of normal activity as not being able to climb the stairs
Finally in Severe persistent asthma
Symptoms occur throughout the day
Patient awakens nightly
Activity is extremely limited as not being able to walk to the bathroom