Asthma

Diagnosis

Physical exam

To rule out further illnesses, such as a respiratory infection or chronic obstructive pulmonary disease (COPD), your doctor will do a physical examination. Your doctor will also inquire about your signs and symptoms as well as any further health issues.

Lung function test

To measure how much air you breathe in and out, you could undergo a lung function test. These tests could consist of:

• Spirometry. By measuring how much air you can exhale after taking a deep breath and how quickly you can breathe out, this test calculates the constriction of your bronchial tubes.
• Peak flow. A simple tool called a peak flow meter assesses how forcefully you can exhale. Peak flow measurements that are lower than normal indicate that your lungs may not be functioning as well and that your asthma may be becoming worse. You’ll receive guidance from your doctor on how to monitor and manage low peak flow values.

Before and after using a bronchodilator, such as albuterol, a medicine to open your airways, lung function tests are frequently conducted. You probably have asthma if using a bronchodilator helps your lung function to improve.

Additional tests

Additional tests to identify asthma include:

• Methacholine challenge. A well-known asthma trigger is methacholine. It will produce a small narrowing of your airways when inhaled. It’s likely that you have asthma if you react to the methacholine. Even if your initial lung function test is normal, this test might still be used.
• Imaging tests. A chest X-ray can aid in locating any structural abnormalities or illnesses (such as infections) that may contribute to or exacerbate breathing issues.
• Allergy testing. Allergies can be diagnosed through skin testing or blood tests, which can identify whether a person is allergic to substances such as dust, mold, pollen, or animals. If an allergic trigger is identified, a doctor may recommend allergy shots as a treatment option.
• Nitric oxide test. The nitric oxide gas in your breath is measured by this test. Nitric oxide levels may be higher than usual when your airways are inflamed, which is a sign of asthma. Not many people have access to this test.
• Sputum eosinophils. This examination looks for certain white blood cells (eosinophils) in the saliva and sputum you cough up. When symptoms start to appear, eosinophils are already present, and they become apparent when stained with a rose-colored dye.
• Provocative testing for exercise and cold-induced asthma. Your doctor will do these tests before and after you engage in strenuous exercise or take numerous deep breaths of cold air, and they will measure your airway obstruction.

Asthma classification

Your doctor will classify the severity of your asthma based on the frequency and severity of your signs and symptoms. Your physical examination and diagnostic testing will both be taken into account by your doctor.

Your doctor can select the appropriate course of action based on the severity of your asthma. Asthma severity frequently changes over time, necessitating modifications to treatment.

Four broad categories are used to categorize asthma:

Asthma classification	Signs and symptoms
Mild intermittent	mild symptoms up to two nights per month and up to two days each week
Mild persistent	more than twice per week, but never more than once in a single day, in terms of symptoms
Moderate persistent	symptoms that appear daily and more than once a week at night
Severe persistent	most days, symptoms occur throughout the day and frequently at night.

Treatment

Preventing asthma episodes is crucial for long-term management of the condition. Treatment typically involves identifying triggers, taking necessary precautions to avoid them, and monitoring breathing to ensure that medication is effectively managing symptoms. If asthma symptoms flare up, a quick-relief inhaler may be needed.

Medications

Your age, your symptoms, your asthma triggers, and what best controls your asthma will determine the best drugs for you.

Medication used for long-term prevention and control lessens the inflammation that causes swelling in your airways and causes symptoms. Breathing is restricted by swollen airways, which are promptly opened by quick-relief inhalers (bronchodilators). Medication for allergies is sometimes required.

Long-term asthma control medications, They are the cornerstone of asthma treatment and are often taken daily. These drugs lessen your risk of having an asthma attack and keep your asthma under control on a daily basis. Long-term control drug classes include:

• Inhaled corticosteroids. Fluticasone furoate, fluticasone propionate, budesonide, ciclesonide, beclomethasone, and mometasone are some of the drugs in this group.

Before these drugs provide their full benefit, you might need to take them for a few days to a few weeks. In contrast to oral corticosteroids, inhaled corticosteroids carry a lower risk of serious side effects.

• Leukotriene modifiers. These oral drugs, such as zileuton, zafirlukast, and montelukast, reduce asthma symptoms.

Montelukast has been connected to emotional responses such agitation, violence, hallucinations, depression, and suicide thoughts. In the event that you encounter any of these responses, get medical help right away.

• Combination inhalers. A long-acting beta agonist and a corticosteroid are both present in these drugs, which include fluticasone-salmeterol, budesonide-formoterol, formoterol-mometasone, and fluticasone furoate-vilanterol.
• Theophylline. By relaxing the muscles around the airways, theophylline, a daily tablet, aids in maintaining the airways’ openness. It’s less frequently prescribed than other asthma drugs and necessitates routine blood tests.

Quick-relief (rescue) medications provide quick, temporary symptom relief during an asthma attack, as required. Additionally, if your doctor advises it, they may be taken prior to working out. Some examples of quick-relief drugs are:

• Short-acting beta agonists. When an asthma attack strikes, these inhaled, quick-relief bronchodilators quickly relieve symptoms. Levalbuterol and albuterol are a couple of examples.

A portable hand-held inhaler or a nebulizer, a device that turns asthma drugs into a fine mist, can be used to provide short-acting beta agonists. A face mask or mouthpiece is used to inhale them.

• Anticholinergic agents. Ipratropium and tiotropium act swiftly to instantly relax your airways, making it easier to breathe. This is similar to how other bronchodilators work. Although they can be used to treat asthma, they are mostly used to treat emphysema and chronic bronchitis.
• Oral and intravenous corticosteroids. These drugs, which also include prednisone and methylprednisolone, reduce the inflammation of the airways brought on by severe asthma. These medications are only used temporarily to treat severe asthma symptoms because long-term usage can have substantial negative effects.

An immediate-relief inhaler helps relieve your symptoms if you are experiencing an asthma attack. But if your long-term control meds are performing as intended, you shouldn’t need to use your quick-relief inhaler very frequently.

Record the number of puffs you use each week. Consult your doctor if you find that you need to use your quick-relief inhaler more frequently than is advised. Most likely, you need to change the dosage of your daily control prescription.

Allergy medications may be beneficial if allergies cause your asthma to flare up or become worse. These consist of:

• Immunotherapy (allergy shots). Allergy shots gradually lessen the immune system’s response to particular allergens over time. For a few months, you typically get shots once a week. Then, for three to five years, you get shots once a month.
• Biologics. Omalizumab, mepolizumab, dupilumab, reslizumab, and benralizumab are among the drugs that are especially prescribed for persons with severe asthma.

Bronchial thermoplasty

When other long-term asthma drugs or inhaled corticosteroids are ineffective at treating severe asthma, this therapy is utilized. It is neither widely accessible nor suitable for everybody.

Your doctor uses an electrode to heat the interior of the lungs’ airways during bronchial thermoplasty. The smooth muscle in the airways is reduced by the heat. This reduces the airways’ capacity to constrict, which facilitates breathing and may lessen asthma attacks. Three outpatient visits typically make up the length of the therapy.

Treat by severity for better control

To effectively manage asthma, your medical treatment should be adjusted according to changes in symptoms. Your doctor should regularly inquire about your symptoms during each visit and adjust your treatment plan accordingly. For example, if your asthma is well-controlled, your doctor may suggest reducing your medication. However, if your asthma is not under control or worsening, your doctor may recommend taking additional medication and scheduling more frequent appointments.

Asthma action plan

Create an asthma action plan with your doctor that specifies in writing when to take specific drugs or when to change the dose of your medications based on your symptoms. List your triggers as well as the steps you must take to avoid them.

To check how well your medication is regulating your asthma, your doctor may also advise keeping track of your symptoms or regularly using a peak flow meter.