Asthma - Diagnosis and Treatment

Diagnosis

Physical Evaluation

A health provider begins by looking for signs that suggest asthma or other health problems, such as respiratory infections or chronic lung disease. The provider asks about symptoms like coughing, wheezing, chest tightness, or shortness of breath.

The doctor checks for other conditions that might cause similar breathing problems. During the exam, the provider listens to the lungs with a stethoscope for wheezing or other abnormal sounds.

They also check for signs of allergies or sinus issues, which can occur alongside asthma.

Tests to Check How Your Lungs Work

Doctors use several tests to see how well your lungs are working:

Test Name	What It Checks	What It Shows
Spirometry	Measures how much air you can blow out and how fast.	Checks for narrowed airways.
Peak Flow Meter	Looks at how hard you can breathe out.	Detects lung function changes.

These breathing tests help find airway narrowing and spot airflow problems. Providers usually perform these tests before and after you use a bronchodilator like albuterol, which opens the airways.

If your lung function improves after using this medicine, it suggests you may have asthma.

Other Helpful Tests

Doctors use extra tests to confirm asthma or look for other causes of breathing problems.

Methacholine Challenge Test: You breathe in a substance that may narrow your airways. If it triggers symptoms, asthma is likely.
Imaging Studies: Chest X-rays look for other lung diseases or causes of symptoms.
Allergy Tests: Skin or blood tests check for reactions to pollen, dust, mold, or animal dander. Results can show allergic asthma triggers.
Exhaled Nitric Oxide Test (FeNO): This test measures nitric oxide levels in your breath. Higher levels suggest airway inflammation.
Sputum Eosinophil Count: This test looks for certain white blood cells (eosinophils) in mucus you cough up. High counts can happen with some types of asthma.
Activity and Cold Air Challenge: This test measures how your lungs react after exercise or breathing cold air. Some people have asthma symptoms only during activity or when exposed to cold.

These tests provide more information about your asthma symptoms, airway inflammation, or other lung diseases.

Types and Levels of Asthma

Doctors group asthma by how often and how strongly symptoms appear, along with test results. Asthma type depends on the frequency and intensity of wheezing, cough, chest tightness, and shortness of breath.

Asthma Group	Daytime Symptoms	Nighttime Symptoms
Mild, off and on	Up to 2 times a week	Up to 2 times a month
Mild, regular	More than twice a week	Up to once a week
Moderate, ongoing	Every day	More than once a week
Severe, constant	Most days	Most nights

Asthma can change over time. Your symptoms or test results may become milder or more severe.

Providers use this classification to plan treatment and make changes if your asthma improves or worsens. Severity also depends on test results like spirometry or peak flow, and signs of airway inflammation from breath or blood tests.

Treatment

Common Medicines for Asthma

Doctors often manage asthma with a mix of medicines taken daily or as needed. Medications fall into two main types: long-term controllers and quick-relief options.

Long-Term Control Medications

Inhaled corticosteroids help prevent airway swelling and lower the risk of severe attacks.
Leukotriene modifiers are taken by mouth and block substances that cause airway swelling.
Combination inhalers blend a corticosteroid with a long-term bronchodilator.
Xanthine derivatives are an older pill that relaxes airway muscles. People taking it need regular blood checks.

Quick-Relief (Rescue) Medications

Short-acting beta agonists work fast to relax airway muscles and are used during attacks or before exercise.
Anticholinergic agents relax airway muscles but are used more often for other lung diseases.
Oral or intravenous corticosteroids are used for short periods if asthma becomes severe.

Medicine Tracking Table

Medication Type	Purpose	Frequency
Inhaled corticosteroids	Long-term control, reduce swelling	Daily
Leukotriene modifiers	Oral tablets, control inflammation	Daily
Combination inhalers	Combine two drugs for better control	Daily
Theophylline	Relaxes airway muscles	Daily
Short-acting beta agonists	Fast-acting relief	As needed
Oral corticosteroids	Severe asthma, short-term use	As needed

Allergy Treatments

Allergy shots (immunotherapy) may help if allergies trigger your asthma.
Biologic drugs can help people with severe asthma not controlled by standard medicines.

Track how often you use quick-relief inhalers. If you need them often, your doctor may need to adjust your long-term control medicines.

Heat Treatment for Severe Asthma (Bronchial Thermoplasty)

If your severe asthma does not improve with regular medicines and inhaled corticosteroids, your doctor may suggest bronchial thermoplasty.

A special tool applies gentle heat to the airways inside your lungs. The heat reduces the thickness of airway muscles, making it less likely for airways to tighten.

Doctors usually give this treatment over three outpatient visits. Not all clinics offer this therapy, and it is mainly for adults with hard-to-treat asthma.

The main goal is to make breathing easier and reduce asthma attacks when regular medications do not help.

Adjusting Asthma Therapy by Severity: A Flexible Plan

Doctors change asthma treatment as your symptoms change. This is called a “stepwise” method.

Key points in the stepwise approach:

The doctor reviews your symptoms and control at each visit.
If your asthma is well controlled, you may need less medicine.
If your symptoms are not controlled or get worse, you may need more medicine and more frequent visits.

Typical Stepwise Approach Table

Symptom Level	Medication Plan	Monitoring
Mild, well controlled	Fewer or lower doses of medicines	Less frequent
Moderate or worsening	Increase dose, consider additional meds	Review more often
Severe or frequent	High-dose meds, add new treatments if needed	Frequent checks

This flexible plan helps you get the right therapy for your current needs.

Personalized Asthma Self-Management Plan

A written asthma plan helps you respond quickly and safely to changes in your symptoms.

The plan, made with your healthcare provider, lists daily medicines, steps to take if symptoms get worse, and when to use quick-relief inhalers.
It includes your asthma triggers and ways to avoid them.

Tracking symptoms with a diary or peak flow meter at home shows how well your therapy is working. Your plan also tells you when to call your doctor or seek emergency care.

Asthma Management Plan Checklist:

List all daily and rescue medicines.
Know your asthma triggers and how to avoid them.
Monitor symptoms and lung function regularly.
Know when to change medicines, increase doses, or seek emergency care.

Practical Steps to Improve Daily Life and Home Environment

Limit Exposure to Asthma Irritants

Managing asthma at home means finding and reducing contact with things that make symptoms worse. Common triggers include dust mites, pollen, mold, pet dander, cold air, tobacco smoke, and air pollution.

Air Quality Control: Use air conditioning to keep out pollen and reduce humidity, which discourages dust mites. If you do not have air conditioning, keep windows closed during pollen season.
Reducing Dust and Allergens: Replace or cover bedroom items that collect dust. Use dustproof covers for mattresses, pillows, and box springs.

Bedding and curtains should be washable. Hardwood or linoleum floors are easier to clean than carpets.

Tips to Reduce Indoor Allergens	Examples
Bedding covers	Use dustproof or allergen-proof covers
Flooring	Prefer hardwood or linoleum
Cleaning frequency	Once a week or more
Curtains and blinds	Washable materials
Remove clutter	Less surface area for dust to settle

Control Dampness and Mold: Use dehumidifiers in damp homes to lower mold risk. Clean bathrooms and kitchens regularly to prevent mold growth. Remove damp items like wet firewood or leaves from near the house.
Pet Allergens: If you are allergic to animals, avoid pets with fur or feathers. If you cannot avoid them, bathe and groom pets often to lower dander in the home.
Cleaning Routine: Clean frequently to remove dust, mold, and allergens. If you are sensitive, wear a mask or ask someone else to clean. Wash bedding often in hot water.
Protection During Cold Air: Wear a face covering outdoors in cold or dry weather to protect your airways, especially if you have exercise-induced asthma.

Maintain Good Health Habits

Staying generally healthy supports better asthma control. Healthy habits can lessen the impact of triggers.

Physical Activity: Moving regularly strengthens the lungs and heart. Doctors often recommend exercise for people with asthma, especially when they use prescribed treatments to prevent symptoms.

When exercising outside in chilly air, wearing a mask warms up the air before you breathe it in.

Healthy Weight: Extra weight can make asthma harder to manage. Keeping a healthy weight may help reduce symptoms and lower the risk of breathing problems.
Digestive Health: Heartburn and gastroesophageal reflux (GERD) can make asthma worse. Treating these issues can protect lung health and make breathing easier.

Alternative Approaches to Treatment

People sometimes use alternative methods along with regular medicine to help manage asthma. These options should not replace prescribed treatments.

Some common choices include:

Breathing Exercises: Practicing special ways of breathing can help some people need less medicine for their symptoms.
Herbal Remedies and Natural Supplements: People often try black seed, caffeine, choline, and pycnogenol. There is not enough research to know how well they work or if they are safe.
Precautions: Always check with a doctor before trying herbs or supplements. Some can mix poorly with asthma medicine.

Alternative Practice	Notes
Breathing exercises	Might help reduce the need for medicine
Herbal/natural remedies	Black seed, caffeine, choline, pycnogenol; ask doctor first

Finding Ways to Manage and Get Help

Living with asthma can feel difficult. People might feel frustrated, sad, or worried about changing activities or needing daily medicine.

Some may feel embarrassed about having asthma or using inhalers in public. These feelings are common, but there are ways to make daily life easier and gain more control.

Making small changes can help reduce stress:

Set Realistic Goals: Use a daily list for tasks to keep things manageable. Celebrate small wins to stay motivated.
Take Breaks: Pause and rest between activities, especially if they might trigger symptoms.
Talk to Others: Support groups let people share stories and tips. It helps to know others face the same challenges.
Encourage Children: Adults should focus on what the child can do. Friends, teachers, and coaches can all support asthma management at school and during play.

Coping Tip	Benefit
Take breaks	Fewer asthma triggers
Make to-do lists	Less stress, more control
Join a support group	Emotional support
Stay positive	Improves mood for children

Getting Ready for Your Visit

Steps to Prepare Before Meeting Your Doctor

Take a few key actions before your appointment to make the visit more helpful.

Write down any symptoms you have, even if they seem unrelated. This makes it easier to remember everything you want to discuss.
Track when symptoms are at their worst. Note days, times, or situations that make symptoms flare up, such as being outside in pollen or when the weather is cold.
Include important personal details, such as major stress or changes in your life. Write down any health issues or big events, as these might affect your health.
List all the medicines, vitamins, and supplements you use. Include prescription and over-the-counter drugs. This helps your health care provider avoid prescribing something that could cause a bad reaction.
Bring a family member or friend with you. A second person can remember details you might miss or help explain how your symptoms affect your daily life.
Prepare questions for your health care provider. Use a numbered or bulleted list, ranking your concerns from most to least important.

Here are sample questions you might ask:

What is the main cause of my breathing trouble?
Could there be any other reasons for these symptoms?
Will I need any tests, like lung function or allergy tests?
Should I expect this issue to be long-term?
What treatment do you suggest? Are there other options?
Will I be able to manage this along with my other health conditions?
Are there any limits or special steps I should follow at home or school?
Do I need to see a specialist, such as an allergist or pulmonologist?
Is there a cheaper generic medicine I can use?

Having a list ready helps you use your time wisely and ensures you do not forget anything.

Here is a simple checklist to help you organize:

What to Bring	Why It Matters
Symptom notes	Accurate discussion
Medication and supplement list	Prevents drug issues
List of personal events	Reveals possible health links
Written questions	Makes best use of appointment
Family member or friend	Extra support and memory

How Your Health Care Provider Will Guide the Visit

Your doctor or specialist will try to understand your health history and current symptoms. Be ready for detailed questions about your breathing, when problems started, and whether your symptoms are steady or come and go.

Expect questions such as:

What symptoms are you having right now?
When did you first notice these symptoms?
Are your symptoms mild, moderate, or severe?
Are the problems there all the time or only in certain situations?
Do you have allergies, skin rashes, or nasal problems?
What makes your symptoms better or worse?
Does asthma or allergies run in your family?
Do you have other long-term health conditions?

Your health care provider may ask you about common triggers, like cold weather, dust, pet dander, activity, or stress. They might also ask if others in your family have similar problems.

Doctors want full, honest answers so they can recommend tests or create a treatment plan. Bring notes to help you remember details if you feel nervous or rushed.

Asthma – Diagnosis and Treatment