Assess People With Risk Factors For Asthma
Risk factors for asthma include a mix of genetic, epigenetic, and environmental factors.4 Genetics is concerned with characteristics we inherit from our parents, and epigenetics is the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code. Although we may be able to modify environmental factors, we can do little to alter genetic or epigenetic factors.
When assessing risk, looking at a personâs current control can help us to understand their health-related quality of life and future risk.7,8 Control is defined as no night-time awakenings due to asthma, minimal symptoms, little requirement for rescue medication, minimal side effects from medication, normal lung function, and no visits to the accident and emergency department.9 If control is good, then exacerbations, unstable or worsening symptoms, and side effects from medication should be reduced, and loss of lung function and, ultimately, death can be avoided.2,9
Those at high risk of severe asthma should be closely monitored, and we should be cognisant of the features that increase the risk of asthma exacerbations and death, such as a prior accident and emergency visit, hospital admission, or an intensive care unit admission for asthma.8
Approach To Asthma Diagnosis
Asthma should be suspected in patients with recurrent respiratory symptoms, particularly cough, wheeze, chest tightness and dyspnea. Alternative diagnoses should be excluded. An objective lung function test such as spirometry can be used to confirm airway obstruction and to demonstrate reversibility of obstruction with bronchodilator medication.
Diagnosing And Managing Adult Asthma
May 2, 2022
As spring brings more outdoor activities and pollinating plants, its a peak season for asthma and allergies. This Asthma Awareness Month, Dr. Tina Bradley with Clark Primary Care shares about this common condition as it relates to adult-onset asthma.
Getting asthma as an adult
Although many people first develop asthma during childhood, asthma symptoms can occur at any time in life. Several factors may make someone more likely to develop adult-onset asthma. Women are more likely to develop asthma after the age of 20 than men, so hormonal fluctuations may play a role, with many women experiencing their first attack during pregnancy or menopause.
Adult-onset asthma can also be triggered by allergies. Exposure to allergens or irritants such as cigarette smoke, chemicals, mold, dust or other substances commonly found in our environment might trigger the first asthma symptoms. Different illnesses, viruses or infections can also be a factor in adult-onset asthma. Other risk factors are a family history of asthma and being overweight.
Adult-onset asthma can differ from childhood asthma in that childhood asthma is more often characterized by intermittent flare-ups, whereas adult-onset asthma tends to have more persistent symptoms that may require daily medications to keep under control.
Asthma symptoms and diagnosis
Asthma symptoms can include:
Environmental factors in our area
Factors in our area that affect this include:
Managing your asthma
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Box 4 Key Messages For The Diagnosis Of Asthma In Adults
- The diagnosis of asthma should be suspected in patients with recurrent cough, wheeze and dyspnea in whom no alternative diagnosis can be found and should be confirmed by an objective measurement of lung function or, if normal, by tests for bronchial hyperresponsiveness .
- A clinical diagnosis of asthma should be prompted by symptoms such as episodic breathlessness, wheezing, cough, sputum and chest tightness .
- Measurements of lung function by spirometry or peak expiratory flow provide an assessment of the severity of airflow limitation, its reversibility and its variability, and can be used to confirm the diagnosis of asthma .
- Measurements of allergic status can help to identify risk factors that cause asthma symptoms in individual patients .
- Because the obstruction observed in asthma is variable, it is possible for the spirometry results to be normal for a patient who has asthma. Options to confirm asthma include bronchial challenge tests, serial peak flow monitoring and measurements of inflammation .
- For patients with symptoms consistent with asthma who have normal lung function, measurement of airway responsiveness may help to establish the diagnosis .
- Challenge testing is potentially useful in patients with typical symptoms but normal spirometry results or atypical symptoms or possible occupational asthma .
Asthma Symptoms Can Mimic Other Illnesses Or Diseases Especially In Older Adults For Example:
- Hiatal hernia, stomach problems, heart failure, or rheumatic arthritis can create asthma-like symptoms.
- Chronic obstructive pulmonary disease has many of the same symptoms as asthma. COPD, which includes emphysema and chronic bronchitis, is very common in older adults especially those who are or have been smokers.
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When Should You Have A Spirometry Test
Children older than age five, and adults of any age, who have asthma-like symptoms should have a spirometry test. The healthcare provider should also do a physical exam and a full medical history. If the test shows that you have asthma, your doctor should prescribe asthma medicine. Then you should be retested four to six weeks later. If your test results improve, your treatment is working. You may even be able to take less medicine. If your symptoms get worse, you should have another spirometry test. If your symptoms are controlled, you should have a test at least once every year or two.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
What Causes Adults To Develop Asthma
At least 30% of adult asthma cases are triggered by allergies. People who are allergic to cats may have an increased risk for developing adult onset asthma. Exposure to allergens or irritants such as cigarette smoke, chemicals, mold, dust, or other substances commonly found in the persons environment might trigger the first asthma symptoms in an adult.
Prolonged exposure to certain workplace materials may set off asthma symptoms in adults.
Hormonal fluctuations in women may play a role in adult onset asthma. Some women first develop asthma symptoms during or after a pregnancy. Women going through menopause can develop asthma symptoms for the first time.
Different illnesses, viruses, or infections can be a factor in adult onset asthma. A bad cold or a bout with the flu is often a factor in adult onset asthma.
Smoking does not cause adult onset asthma however, if you smoke or if you are exposed to cigarette smoke , it may provoke asthma symptoms.
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Management Of Poor Or Incomplete Response To Long
If there is a poor or non-response to proposed treatment plan, consider the following:
1. Poor adherence with medications due to:
- cost of prescribed medications is a significant barrier. Ensure patient can afford the medication prescribed. Discuss patients drug plan to ensure appropriate coverage. See Appendix C Asthma Medication Table
- inhaler burden try to prescribe less inhalers if possible
2. Incorrect inhaler technique – prescribe spacer and review its use.20
3. Review and readdress risk factors and co-morbidities .
4. Confirm and review diagnosis and refer to specialist for further investigation.
What Is Adult Asthma
Asthma is a disease that includes the symptoms of wheeze, cough and breathing difficulty. These symptoms are caused by issues in the airways that cause problems with breathing:
- Airway obstruction when the airways are blocked from swelling or extra mucus
- Airway inflammation when the airways are irritated causing swelling and narrowing
- Bronchial hyper-responsiveness when the airways are overly sensitive and easily react to an irritant such as smoke, cold air or exercise. When they react, they get smaller, making breathing difficult.
Asthma can vary between people and often not all of the above symptoms happen in everyone. Symptoms can also come and go over time.Adult asthma refers to asthma that affects people aged over 18. For children aged between 5 and 18, there are separate guidelines that are used for diagnosis.
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Fractional Exhaled Nitric Oxide Test
If after routine testing, an asthma diagnosis isn’t certain, a fractional exhaled nitric oxide test may be performed. This test is often simply referred to as a FeNO test.
A FeNO test uses a handheld device to measure the amount of nitric oxide you exhale. Having a high level of nitric oxide in your exhaled breath often means your airways are inflamed .
What Are Signs And Symptoms Of Adult Onset Asthma
Regardless of age, asthma symptoms can include:
Dry cough, especially at night or in response to specific triggers
Tightness or pressure in the chest
Wheezing a whistling sound when exhaling
Shortness of breath after exercise or physical exertion
Colds that go to the chest or hang on for 10 days or more
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How To Get A Diagnosis
The first thing to do is book an appointment. Your GP or an asthma nurse can help confirm or rule out a diagnosis of asthma.
They can do this by:
- talking about your symptoms, what sets them off, and when you get them
- asking if anyone else in the family has asthma
- finding out if you, or anyone in your family, have other allergies, like hay fever
- testing how your lungs are working
- listening to your chest for any sounds of wheezing
- prescribing asthma treatments to see if they make a difference
- considering any other symptoms that might suggest something else.
Alongside a full clinical assessment by your GP, youll need some asthma tests to confirm or rule out asthma. Your GP can see how your lungs are working with tests like peak flow, spirometry, and FeNo .
Your GP can usually perform these tests during the appointment, and you can see the results straight away. But you may need to do tests again on another day before your GP can confirm you have asthma.
You may be given a peak flow meter to use at home for a couple of weeks. This is so you can record your own peak flow scores in a diary.
When you take it back to your appointment, your GP or asthma nurse will be able to see a pattern of scores that could suggest asthma.
Trying out asthma treatments
Your GP or asthma nurse may prescribe asthma treatments to see if they help. This is sometimes called a trial of treatment.
If your symptoms start to get better, it suggests you could have asthma.
Video: How Is Asthma Diagnosed
Transcript for âHow is asthma diagnosed?â
0:00 If you or your GP suspect that you may have asthma, they will start off by making sure theyâve got an accurate
0:07 history of your symptoms, your lifestyle, any past medical history, and also family history â to see if asthma is a
0:16 possibility. To help with diagnosing asthma, itâs important to do some tests, to find out exactly how well your lungs are working, and to be able to identify
0:27 whether theyâre inflamed, which is a key aspect of asthma. One of the tests youâll be asked to do is to blow into a peak flow meter. This is a childâs version.
0:37 Itâs very difficult to diagnose asthma in children, but once theyâre about 5 to 6 years of age they may be able to blow into one of these. Blowing into one of
0:47 these will give us a reading of how fast you can blow your air out. You may be asked to take this home with you and to record peak flow readings over several
0:59 times a day to get a variation, and that will help the doctor actually diagnose whether youâve got asthma or not. Youâll also be asked to do a spirometry test.
1:09 This measures lung function how much your lungs actually can hold, and how quick you can blow your air out. Now this takes a little bit more time, and you would have to attend the surgery to have
1:37 inhaler, through the spacer, and after 20 minutes youâll be expected to do the test again. And these results will show us, compared with your age and your
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Asthma Uk Is Here To Support You
We also have lots of tips on living with asthma, from doing sports and going on holiday, to studying with asthma and having relationships.
Explore our health advice web pages and . The more you know about your asthma, the better youll be able to work with your GP or asthma nurse to manage it well.
Speak to someone about your asthma
You can also call our Helpline on 0300 222 5800 to speak to a respiratory nurse specialist. Or you can WhatsApp them on 0307378 606 728.
You can ask them anything from symptoms and treatments to living life without asthma getting in the way.
Next review due February 2024
Why Is My Asthma Worse At Night
Asthma that gets worse at night is sometimes called nighttime asthma or nocturnal asthma. There are no definite reasons that this happens, but there are some educated guesses. These include:
- The way you sleep: Sleeping on your back can result in mucus dripping into your throat or acid reflux coming back up from your stomach. Also, sleeping on your back puts pressure on your chest and lungs, which makes breathing more difficult. However, lying face down or on your side can put pressure on your lungs.
- Triggers in your bedroom and triggers that happen in the evening: You may find your blankets, sheets and pillows have dust mites, mold or pet hair on them. If youve been outside in the early evening, you may have brought pollen in with you.
- Medication side effects: Some drugs that treat asthma, such as steroids and montelukast, can affect your sleep.
- Air thats too hot or too cold: Hot air can cause airways to narrow when you breathe in. Cold air is an asthma trigger for some people.
- Lung function changes: Lung function lessens at night as a natural process.
- Asthma is poorly controlled during the day: Symptoms that arent controlled during the day wont be better at night. Its important to work with your provider to make sure your asthma symptoms are controlled both day and night. Treating nighttime symptoms is very important. Serious asthma attacks, and sometimes deaths, can happen at night.
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What Are Risk Factors For Developing Asthma As An Adult
Any adult can develop asthma. However, there are things that may lead people to develop asthma including:
- Family history of asthma
- Occupational or job-related exposure
- Air pollution
While none of these factors determine if you develop asthma as an adult, they should be considered if you start experiencing symptoms of asthma.
How Is Asthma Treated
Asthma can be controlled, but there’s no asthma cure. There are, however, certain goals in asthma treatment. If you are unable to achieve all of these goals, it means your asthma is not under control. You should contact your asthma care provider for help with asthma.
Treatment goals include the following:
- Live an active, normal life
- Prevent chronic and troublesome symptoms
- Attend work or school every day
- Perform daily activities without difficulty
- Stop urgent visits to the doctor, emergency room, or hospital
- Use and adjust medications to control asthma with little or no side effects
Properly using asthma medication, as prescribed by your doctor, is the basis of good asthma control, in addition to avoiding triggers and monitoring daily asthma symptoms. There are two main types of asthma medications:
Asthma medications can be taken by inhaling the medications or by swallowing oral medications . If you are also taking drugs for other conditions, you should work with your providers to check drug interactions and simplify medications when possible.
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Assessment Of Asthma Control
Assess asthma control at the time of diagnosis, when creating/modifying a treatment plan and when monitoring treatment outcomes. Consider both symptom control and risk of a future asthma attack.
0 points = well controlled asthma symptoms
1-2 points = partly controlled asthma symptoms
3 points = uncontrolled asthma symptoms
Does the patient have any of the following risk factors:
- 1 severe attack in last 12 months
- Uncontrolled asthma symptoms
- Inadequate inhaled corticosteroid : not prescribed ICS poor adherence incorrect inhaler technique
- Low FEV1, especially if < 60% predicted
- Major psychological or socioeconomic problems
- Sputum or blood eosinophilia
If the patient has any of these risk factors they are at risk for future asthma attacks. Consider strategies to eliminate modifiable risk factors .
Second Stage: Mild Persistent Asthma
Although this stage is still relatively mild, asthma is beginning to become more noticeable and starting to interfere with your quality of life.
Symptoms. In mild persistent asthma, daytime symptoms are occurring 3 to 6 times a week. Nighttime symptoms interfere with sleep nearly every week, or 3 to 4 times a month. Flare-ups are more severe and may affect activity levels.
Lung function tests. As with intermittent asthma, the FEV1 is 80% or more above normal values. Peak flow readings show less than 20-30% variability.
Treatment. A low dose inhaled steroid will be used as a controller medication to prevent and control symptoms. Less common alternatives might include cromolyn, a leukotriene receptor antagonist , or theophylline. The doctor will also prescribe a quick-relief inhaler for flare-ups.
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How To Tell You Have Asthma
Asthma is a complex disease to diagnose, and only a healthcare professional is able to make a proper diagnosis.
If you are concerned that you may have asthma, contact your healthcare provider. In order to confirm an asthma diagnosis, your healthcare provider will take into account your medical and family history, allergies, and conduct lung function testing such as spirometry.