ASTHMA - DIAGNOSIS

Doctors make the diagnosis of asthma by taking a medical history and conducting a physical examination.  By definition, asthma is characterized by recurrent or chronic wheezing and/or coughing, with variable airway obstruction due to bronchial hyper-sensitivity secondary to airway inflammation.

Hence, a clinical history of recurrent shortness of breath, cough, chest tightness or wheezing, especially if there is a family history of asthma, or associated symptoms of allergic rhinitis, allergic conjunctivitis or eczema, would point to a diagnosis of asthma.  There may be physical signs such as rhonchi (wheezing) heard. 

The diagnosis of asthma, however, in early childhood still remains a challenge for doctors, and is largely based on clinical judgement and an assessment of symptoms and physical signs. Occasionally, some tests are performed, such as spirometry and lung function tests, but these are difficult to perform in children younger than 5 years of age.

Your doctor may put your on a trial of treatment with short-acting bronchodilators (eg. Ventolin) and inhaled glucocorticosteroids. Marked improvement of symptoms supports the diagnosis of asthma.

ASTHMA - MANAGEMENT

The goal of asthma treatment and management is to achieve and maintain good control, such that the patient has minimal symptoms (ie. No sleep disturbance, no early morning shortness of breath, no exercise intolerance), infrequent exacerbations, minimal need for bronchodilator therapy and can have normal physical activities.

An important aspect of asthma management, which should not be forgotten, is trigger avoidance.  Appropriate medication together with trigger avoidance is key to managing asthma.

Medication used in asthma include:

“Reliever” medication – these are the short-acting bronchodilators which bring fast relief during an acute attack. They relax the muscles of the airways causing them to open up. May be administered as an aerosol spray, syrup or tablet.


“Preventer” medication – these medications are anti-inflammatory agents which help prevent acute asthma attacks. They are mostly low dose steroids, which may be used on their own (eg. Beclotide and flixotide) or in combination with long-acting bronchodilators (eg. Seretide and symbicort).


Montelukast – these are leukotriene receptor antagonists. These “sprinkle on” granules and chewable tablets are useful in children with mild persistent asthma. They also provide some protection in exercise-induced asthma and are effective as an add-on therapy in children whose asthma is insufficiently controlled on low-doses of inhaled steroids alone.


Oral steroids – used in short term treatment of acute asthma attacks.


Nebulized medication – your doctor may prescribe medication via a nebulizer for severe acute attacks. This machine pumps a continuous mist of medication, which is inhaled via a face mask. It often brings significant relief.


As the goal of asthma therapy is to achieve control, patients should periodically monitor that control has been achieved and maintained. This can be done via various tools such as the Asthma Control Test (ACT) – a symptom assessment questionnaire. Monitoring of control can also be done by testing lung function with spirometry and peak expiratory flow rates.

Whilst there is no cure for asthma, it is a very treatable disease in which good control can usually be achieved.