Asthma

Diagnosis

Physical exam
During a physical exam, your healthcare professional will check your lungs, chest, and airways to rule out other conditions such as respiratory infections or chronic obstructive pulmonary disease (COPD). They will also ask about your symptoms, medical history, and any other health issues.

Tests to measure lung function
Lung function tests help determine how well air moves in and out of your lungs. Common tests include:

• Spirometry. Measures the amount of air you can exhale after a deep breath and the speed of your exhalation to detect narrowing of the airways.

• Peak flow. A peak flow meter measures how forcefully you can exhale. Low readings can indicate worsening asthma. Your healthcare provider will guide you on tracking and responding to these readings.

These tests are often done before and after taking a bronchodilator, such as albuterol. Improvement after the medication suggests asthma.

Additional tests
Other diagnostic tools may include:

• Methacholine challenge. Methacholine can trigger mild airway narrowing. A reaction may confirm asthma even if other tests are normal.

• Imaging tests. A chest X-ray can detect infections or structural issues contributing to breathing problems.

• Allergy testing. Skin or blood tests identify allergies to triggers like dust, mold, pollen, or pets. Allergy shots may be recommended if triggers are found.

• Nitric oxide test. Measures airway inflammation by detecting nitric oxide levels in the breath.

• Sputum eosinophils. Looks for specific white blood cells in mucus, indicating airway inflammation.

• Exercise and cold-induced testing. Measures airway response to exercise or cold air to detect triggered asthma.

Asthma Classification

Asthma severity is classified based on symptom frequency, physical exam results, and test outcomes. Proper classification helps guide treatment:

Treatment

Asthma treatment focuses on prevention, long-term control, and relief of flare-ups. Key strategies include avoiding triggers, monitoring symptoms, and using medications as prescribed.

Medications

Long-term control medications (taken daily) reduce airway inflammation and prevent attacks:

• Inhaled corticosteroids. Examples include fluticasone, budesonide, ciclesonide, beclomethasone, mometasone, and fluticasone furoate. They gradually improve airway swelling with minimal side effects.

• Leukotriene modifiers. Oral medications like montelukast, zafirlukast, and zileuton reduce inflammation. Monitor for possible psychological effects with montelukast.

• Combination inhalers. Contain a corticosteroid plus a long-acting bronchodilator, e.g., fluticasone-salmeterol or budesonide-formoterol.

• Theophylline. A daily oral medication to keep airways open; requires regular blood testing.

Quick-relief (rescue) medications (used as needed for immediate symptom relief):

• Short-acting beta agonists. Inhalers like albuterol act quickly to open airways during an attack.

• Anticholinergic agents. Ipratropium or tiotropium relax airways and improve airflow.

• Oral or intravenous corticosteroids. Used for severe attacks to reduce inflammation temporarily.

Allergy management

• Allergy shots (immunotherapy). Gradually reduce reactions to allergens over time.

• Biologics. Medications such as omalizumab, mepolizumab, dupilumab, and others target severe asthma.

Other treatments

• Bronchial thermoplasty. For severe asthma, heat is applied to airway walls to reduce muscle tightening, improving airflow and reducing attacks.

Stepwise Approach & Asthma Action Plan

Asthma treatment should adapt based on symptoms and severity.

• Well-controlled asthma may require fewer medications.

• Worsening symptoms may require increased medication or more frequent monitoring.

• An asthma action plan outlines when and how to adjust medications, track triggers, and manage symptoms.

• Regular use of a peak flow meter helps monitor treatment effectiveness.