How Is Asthma Diagnosed?
There are several steps to diagnosing asthma.
Initially, your physician will want to obtain your medical history. This will entail discussing your symptoms in great detail. She will also ask you questions about your health in general. She may ask you questions that do not make sense – but they may help to figure out if you have any conditions that are linked to asthma.
A full physical exam is performed, which will include auscultation of your lungs – this simply means that your physician will listen to your lungs with a stethoscope.
Finally, your physician will order tests to determine how well your lungs are working.
- Spirometry: This test is used in people over the age of 5. The test requires you to breathe into a tiny tube (the spirometer). The spirometer records measurements of the volume of air that you exhaled, as well as how quickly you exhaled. If these measurements are below certain values, it may indicate asthma. Spirometry is also useful in determining the effectiveness of medications prescribed and adherence to medication.
- Challenge test: When your results are normal, but your physician still suspects asthma, spirometry is performed after having you inhale a chemical called methacholine. Methacholine triggers symptoms in people with asthma.
- Exhaled nitric oxide test: This test involves breathing into a tube, which measures the amount of nitric oxide that you exhale. High levels of nitric oxide signify asthma – it is a sign of inflammation in the airways.
Treatment of Asthma
The treatment of your asthma will depend on many factors, such as your symptoms, your triggers, and the cause of your asthma. Luckily, there are many different treatment options for asthma.
Long-term controller medications are typically taken daily. These medications help to prevent asthma symptoms from occurring and thus, keep asthma under control. Options include:
- Inhaled corticosteroids: fluticasone (Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex); although these are corticosteroids, their side effect profile is low, unlike their oral medication counterpart.
- Leukotriene modifiers: montelukast (Singulair); these are oral medications that control symptoms for approximately 24 hours.
- Long-acting beta agonists: salmeterol (Serevent), formoterol (Foradil); these open the airways if taken in conjunction with inhaled corticosteroids.
- Combined inhalers: fluticasone-salmeterol (Advair Diskus), budenoside-formoterol (Symbicort); a long-acting beta agonist is combined with a corticosteroid.
- Theophylline: theophylline is a daily oral medication that relaxes the airways.
Quick-acting/rescue medications are used during an asthma attack or when your symptoms begin to worsen. Options include:
- Short-acting beta agonists: albuterol (ProAir HFA, Ventolin HFA), levalbuterol (Xopenex); these inhalers act within minutes and can also be used through a face mask in the hospital setting or at home for children or people who have a difficult time with inhalers.
- Ipratropium (Atrovent): similar to short-acting beta agonists, ipratropium helps to relax the airways. It is most commonly used for chronic emphysema and bronchitis, but it is sometimes used for asthma.
- Oral corticosteroids: methylprednisolone, prednisone; corticosteroids help to reduce inflammation. They do have a laundry list of side effects, so they are only prescribed when symptoms are very bad and are only prescribed short-term.
What Triggers Asthma?
If you have allergies that trigger your asthma, unfortunately, many things may trigger your symptoms.
The unfortunate thing is that anything can be a trigger. And everyone is unique. We know the common triggers, but no two people are alike. What triggers person A’s asthma will be different than what triggers person B’s – and person C may have a trigger that may not even be on this list!
Common asthma triggers include:
- Cigarette smoke. Exposure to cigarette smoke is not good for anyone, for many reasons, but it can trigger an asthma attack in people with asthma.
- Dust mites. Unfortunately, dust mites live in almost every home, despite your best cleaning efforts. However, keeping dust at bay, placing mattress and pillow protectors over your bedding, washing bedding weekly, and removing clutter from the bedroom can minimize your risk of triggering an asthma attack from dust mites.
- Outdoor air pollution. This one is a tough one because there are so many different pollutants in the environment – and it is difficult to avoid them. The best way to reduce your exposure to air pollution is to limit your exposure by reviewing air quality forecasts and being outside when the pollution level is low.
- Yes, cockroach allergy is real. Cockroaches leave droppings that are highly allergenic. They live in areas where there are food and water sources, so ensuring that your home is free of these sources can minimize your risk of cockroaches in your home. If you do have cockroaches in your home, use traps to get rid of them and sweep every 2 to 3 days to get rid of potential droppings.
- Unfortunately, our pets can be highly allergenic for some people who are sensitive to pet dander. Re-homing your pet is a good idea if your symptoms are extreme. If you are not willing to do this, wash your pet frequently, do not allow your pet in your bedroom, and vacuum or mop weekly.
- This doesn’t mean mold on food. We’re talking about mold in your environment. Control the humidity levels in your home by using a dehumidifier, use air conditioning, fix water leaks, and remove all sources of mold in your home.
- If you have frequent exposure to a wood burning stove or other exposure to smoke, this can trigger your asthma. Limit your exposure.
If environmental allergies trigger your asthma, this can be difficult to control. After all, it isn’t like you can control the atmosphere. However, there are options:
- Immunotherapy: This is a fancy way of saying “allergy shots.” Allergy shots involve injecting tiny amounts of the things that you are allergic to, and increasing the amounts over time; eventually, reducing your immune response to the allergens.
- Omalizumab (Xolair): an injection that is given every two to four weeks, this is given to people who have both environmental allergies and severe asthma.
How to Manage Asthma Attacks
You should always have a plan in place, in case you have an asthma attack.
This involves creating an asthma action plan with your physician.
You should always carry your rescue inhaler and use it at the first sign of trouble – using it early can prevent an emergency situation.
However, if your symptoms worsen, do not hesitate to seek emergency medical attention. Symptoms of a serious attack include:
- Severe breathlessness, especially at night
- An inability to speak, or only be able to say short phrases
- Having to use the accessory muscles to breathe (the sides of your chest)
- Having no improvement with the use of your rescue inhaler
- Having low peak flow readings
Can You Prevent Asthma?
Unfortunately, you cannot prevent asthma. As with many other chronic conditions, many factors may predispose you to asthma – and many of these are not preventable.
What you can do is take your medications as prescribed. You can avoid your triggers to the best of your abilities. You can keep your appointments with your physician so that she can treat your asthma. You can keep a log of your symptoms.
If you’ve read all of this, you know from experience that asthma can be a tough disease to control – but it doesn’t have to control you.
