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How To Rule Out Asthma

Serial Peak Flow Monitoring

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Measurement of peak flow involves having the patient take in as deep a breath as possible and blow it out as hard and fast as possible into the measuring device . The test measures the fastest rate of expired airflow.

The following peak flow parameters support a diagnosis of asthma:

  • Diurnal variation in peak expiratory flow of more than 20%

  • An improvement of at least 60 L/min or at least 20% after inhalation of a rapid-acting bronchodilator

Peak flow measurement is much simpler and cheaper than spirometry and can be used by patients for self-monitoring at home or in the workplace. However, unlike spirometers, peak flow meters do not measure flow rates over time, nor do they measure lung volumes. Furthermore, there is great variation in readings from peak flow meters and in their reference values. Hence, they are not highly reliable for either children or adults. Patient compliance with self-monitoring may also be an issue. Furthermore, peak expiratory flow is less sensitive to changes in airway calibre than is FEV1. Therefore, it is preferable to use peak flow meters only for monitoring asthma, not for diagnosis.

Whats An Asthma Attack

When you breathe normally, muscles around your airways are relaxed, letting air move easily. During an asthma attack, three things can happen:

  • Bronchospasm: The muscles around the airways constrict . When they tighten, it makes the airways narrow. Air cannot flow freely through constricted airways.
  • Inflammation: The airway linings become swollen. Swollen airways dont let as much air in or out of the lungs.
  • Mucus production: During the attack, your body creates more mucus. This thick mucus clogs airways.

Cystic Fibrosis Or Bronchiectasis

CF is a disease that results in shortness of breath, wheezing, and a cough that may be productive of phlegm. While asthma may be a component of their syndrome, it is also associated with chronically progressing bronchiectasis. Bronchiectasis is a condition caused by permanent inflammation and dilation of airways also associated with thick, crusty secretions that increase the likelihood of lung infections that contribute to flare-ups. While asthma medicines may help, they usually also require things like frequent antibiotics, enzyme supplements, proper nutrition, among other things not commonly prescribed for asthma.2-3

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Therapy In The Emergency Department

Patients with mild-to-moderate asthma exacerbations may present to the emergency department to seek medical care. These patients should be treated as an out-patient when following the recommendation detailed above. Patients with severe or life-threatening asthma should always be managed in the emergency department. A focused, expedited history and physical examination should be carried out in all patients. It is critical to rule out other conditions that may mimic a severe asthma exacerbation, such as pneumonia, congestive heart failure, pneumothorax, and myocardial infarction. In patients with a severe exacerbation, careful attention should be placed on the level of consciousness, oxygen saturation, breathing frequency, resting pulse, and blood pressure, and on the use of accessory respiratory muscles. Patients with severe asthma may have a fast deterioration of their clinical presentation, so continuous monitoring of these patients is warranted. In the advanced stages of an asthma exacerbation, the pulmonary physical examination may reveal a silent chest, which may herald impending respiratory failure. Patients with severe asthma should also be monitored for potential complications of asthma, such as pneumothorax, pneumomediastinum, and anaphylaxis.

When To Look For Other Diagnosis

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As specified above, the persistent condition of problematic respiratory symptoms unresponsive to prescribed asthma therapy need to motivate a clinical full reassessment to exclude that the patient was wrongly labeled with the diagnosis of asthma. To be able to do so, all possible conditions which might mimic asthma need to be considered. Some diseases, better defined as comorbidities, might also coexist with a diagnosis of asthma and will be discussed in a specific section.

Table modified from British Guideline on the Management of Asthma, enlists the clinical clues to alternative diagnosis in asthmatic young children . Table lists alternative diagnosis for persistent respiratory symptoms not responding to asthma treatment and the main clinical characteristics for each.

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Patients At Risk For Severe Asthma Exacerbations

Careful consideration should be carried out in patients with risk factors for severe asthma exacerbations. Patients with exacerbations that led to endotracheal intubation, previous admissions to the ICU, a history of multiple hospitalizations in the past year or multiple emergency department visits in the past month, the need of chronic oral corticosteroids use, poor access to health care, and frequent use of rescue inhalers are considered to have increased risk of severe asthma exacerbations and death. Patients with asthma and with these characteristics should be evaluated promptly and treated expeditiously. In addition, a minority of patients with asthma may experience a significant decline in lung function without a change in symptoms. These under-perceivers are at higher risk for near-fatal exacerbations. This article focuses on the approach to manage exacerbations of asthma.

Tests For Other Conditions

The doctor may also do tests for other conditions that can make asthma worse, like:

  • Gastroesophageal reflux disease

The Canadian Lung Association: “Signs and Symptoms of Asthma: Diagnosis.”

National Jewish Medical and Research Center: “How Is Asthma Diagnosed?”

American College of Allergy, Asthma & Immunology: “About Asthma: Diagnosing Asthma.”

Mayo Clinic: âAsthma: Steps in testing and diagnosis.â

Medscape: âAsthma Guidelines.â

American Academy of Asthma, Allergy, and Immunology: “What to expect at the doctor’s office.”

American Lung Association: “Spirometry and Other Lung Function Tests Fact Sheet.”

American Medical Association: Essential Guide to Asthma.

Asthma and Allergy Foundation of America: “Peak Flow Meters.”

Grayson, M. ACP Medicine, 2005.

National Asthma Education and Prevention Program: “Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma — 2002.”

National Heart, Lung and Blood Institute: “Asthma: How is Asthma Diagnosed?”

MedlinePlus: “Pulmonary Function Tests.”

National Lung Health Education Program: “Spirometry.”

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Breathing: Normal Airways Vs Asthma Airways

Normal: In someone with optimal lung function, air is inhaled through the nose and mouth, passing through the trachea before moving into the bronchi . The bronchi branch into smaller tubes, ending in many small sacs called alveoli. Its in the alveoli that oxygen is passed to the blood and carbon dioxide is removed.

Asthma: In someone with asthma, the airways are inflamed, and when triggered, can constrict even more, obstructing airflow to the lungs.

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How Do I Find My Personal Best Number

How is asthma diagnosed?

Your personal best peak flow number is the highest peak flow number you have over a two- to three-week period when your asthma is under good control. Good control is when you feel good and do not have any asthma symptoms.

Everyones asthma is different, so your best peak flow may be different from the average number for someone of your height, weight and gender. Your Asthma Action Plan needs to be based on your personal best peak flow number.

To find out your personal best peak flow number, take peak flow readings:

  • At least two times a day for two to three weeks
  • When you wake up and between noon and 2 p.m.
  • Before and after taking quick-relief medicine
  • When you get a new peak flow meter, even if it is the same kind as you have used in the past
  • As instructed by your doctor

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Respiratory Exam And Medical History

A doctor asks about your childs respiratory symptoms, such as breathlessness, and recent illnesses. You may also discuss whether your child has allergies or a family history of asthma or allergies and whether he or she has been exposed to pets, cigarette smoke, or other possible triggers.

Our doctors look for signs that your child is having difficulty breathing, such as retraction, or sinking in, of the area between the ribs. They also listen for unusual breathing sounds, such as wheezing, which can be difficult to distinguish from other breathing noises.

What You Can Do At Home

To control or loosen mucus at home, you can try the following remedies:

Drink lots of fluids. Drink plenty of water and other fluids, but not things that can dehydrate you, such as coffee and alcohol.

Humidify. Try a cool mist humidifier or hop into a steamy shower to keep your airways moisturized.

Dont smoke or vape anything. Whether from tobacco or , smoke is an irritant and can cause your body to make more mucus.

Try a teaspoon of honey. Though honey doesnt get rid of mucus, it can calm your cough temporarily.

Check air filters. Other irritants in the air can make mucus production worse, so make sure your heating and cooling system filters are clean and up to date.

Take an expectorant. Some cough medicines contain guaifenesin, which loosens mucus so you can cough it up.

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How Is It Evaluated

If chest discomfort is your main symptom, the first step is to rule out a life-threatening problem.2 Your provider will focus on questions such as:4

  • When did the pain or discomfort start?
  • How has it changed?
  • Where do you feel the pain?
  • How would you describe the pain?
  • What factors make it better or worse?

Your initial evaluation may include an electrocardiogram and chest x-ray, unless there is an obvious and non-threatening cause of chest discomfort.4 Your provider probably will not even consider asthma until he or she is sure that you do not have an immediately threatening condition.2

What Are Pulmonary Function Tests


Pulmonary function tests include numerous procedures to diagnose lung problems. The two most common lung function tests used to diagnose asthma are spirometry, exhaled nitric oxide and challenge tests.

Spirometry This is a simple breathing test that measures how much and how fast you can blow air out of your lungs. It is often used to determine the amount of airway obstruction you have. Spirometry can be done before and after you inhale a short-acting medication called a bronchodilator, such as albuterol. The bronchodilator causes your airways to expand, allowing for air to pass through freely. This test might also be done at future doctor visits to monitor your progress and help your doctor determine if and how to adjust your treatment plan.

Exhaled nitric oxide Nitric oxide is a gas that is produced in the lungs and has been found to be an indicator of inflammation. Because asthma is an inflammatory process, this test has become helpful in the diagnosis and management of asthma. The test is performed by having you breathe into a small, handheld machine for about 10 seconds at a steady pace. It then calculates the amount of nitric oxide in the air you breathe out.

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What Is The Difference Between Asthma And Exercise

In exercise-induced bronchoconstriction , people experience airway constriction only when they exercise. In contrast, asthma is a chronic condition. An allergist can help you determine whether the symptoms you experience during physical activity are related to allergies , irritants in the air , EIB, or underlying asthma.

Treating A Tight Chest

Your doctor will conduct tests to determine the cause of your chest tightness. If the tests for a heart attack come back negative, your symptoms may be caused by anxiety.

You should discuss your symptoms with your doctor to determine when to seek immediate medical attention if you experience chest tightness again. It may be possible to link your chest tightness to other symptoms thatll help you identify anxiety versus a cardiac event.

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Diagnosing Asthma In Children

At Hassenfeld Childrens Hospital at NYU Langone, pulmonologistsdoctors who treat children with lung conditionsspecialize in diagnosing asthma, a condition in which the bronchial tubes, or airways, swell and tighten. This can make it difficult for a child to take a deep breath.

Asthma can appear at any age, and doctors arent entirely sure what causes it. Evidence suggests that asthma develops as a result of repeated exposure to the viruses and bacteria that cause respiratory infections, as well as to allergens and other irritants, such as pollen, dust, mold, cigarette smoke, air pollution, and pet dander, which is the dead skin shed by animals.

Exposure to these triggers stimulates the accumulation of cells in the lungs called eosinophils, a type of white blood cell that helps to protect the body from foreign substances. Eosinophils release substances that inflame the airways and make them sensitive to triggers.

When exposed to a trigger, the airways overreact. They become swollen and narrow and release mucus, leading to symptoms such as wheezing. An episode of severe symptoms that comes on suddenly is called an asthma attack.

What Are The Symptoms Of Asthma

Exercise Induced Asthma

Asthma is caused by inflammation and sticky secretions inside the bronchial tubes. These reactions cause the airways to tighten, resulting in:

  • Coughing
  • Chest tightness
  • Rapid breathing

Children with asthma may go for extended periods without symptoms and then have intermittent asthma attacks. The attacks can be brought on by exercise, illness, or other unknown causes.

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After Your Asthma Diagnosis

The good news is there are lots of effective medicines available to help manage your symptoms. With the right treatment plan and good support from your GP you could stay symptom free.

Here are some things you can do straight away to get off to a good start:

Use an asthma action plan

An asthma action plan is a simple tool to help you manage your asthma well. You fill it in with your GP or asthma nurse.

It tells you exactly how to manage your asthma every day and what to do if symptoms get worse. Evidence suggests that using one means youre less likely to end up in hospital with an asthma attack.

Once you’ve got your own, personalised, asthma action plan, take it along to all your appointments to make sure its always up to date.

Know how to use your inhaler

Using an asthma inhaler can be tricky to get right even if youve been using one for some time. Make sure you start using yours in the best way from the beginning. Some inhalers are best used with a spacer.

Your GP should show you how to use your inhaler and spacer in the right way, but you can also ask the pharmacist to show you when you pick up your prescription.

We have some inhaler videos too which you can watch at home.

Go to all your asthma check-ups

When youre first diagnosed, you may need to see your GP or asthma nurse a few times to check how well your treatment is working. You can also talk about how youre coping with your asthma.

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Asthma Signs & Symptoms

People with asthma experience symptoms due to inflammation in the airways. They might only occur when you encounter an asthma trigger. Common symptoms that can lead to a diagnosis of asthma include:

  • Persistent or recurring coughing: which often occurs at night or early in the morning, although it can happen at any time. Coughing is a major feature of asthma, especially in children and can sometimes be the only sign of asthma.
  • Wheezing: is difficulty breathing accompanied by a whistling sound coming from your airways
  • Shortness of breath: gives you the feeling that you cant get enough air into your lungs, and may even find it difficult to eat, sleep or speak
  • Chest tightness: an unpleasant sensation of heaviness or pressure in the chest that can make it hard to breathe
  • Increased mucus production: is characterized by high levels of thick fluid or phlegm accumulating in your airways
  • Difficulty breathing while exercising: having trouble breathing while performing physical activities can be a sign of asthma
  • Losing Sleep: Being unable to sleep through the night because of breathing troubles

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What Is An Asthma Action Plan

Your healthcare provider will work with you to develop an asthma action plan. This plan tells you how and when to use your medicines. It also tells you what to do if your asthma gets worse and when to seek emergency care. Understand the plan and ask your healthcare provider about anything you dont understand.

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How Do I Prepare For Pulmonary Function Tests

Asthma Attack And No Inhaler

Ask your doctor if there is anything you need to do to prepare for spirometry.

Before taking a challenge test, be sure to tell your doctor if you have recently had a viral infection, like a cold, or any shots or immunizations, since these might affect the test’s results.

Other general preparations to follow before the test include:

  • No smoking on the day of the test
  • No coffee, tea, cola, or chocolate on the day of test
  • Avoid exercise and cold air exposure on the day of test
  • Medicines taken to treat asthma can affect the test results. Different medicines must be stopped at different intervals. You will be told how long before testing to discontinue any medicines you are taking.

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What Causes Heaviness In Chest And Throat

It is quite common for an individual to experience a sensation of heaviness in the chest and throat on an occasional basis. However, heaviness in the chest and throat can cause a lot of discomfort and interferes with routine activities of an individual. It is not always that this sensation is related to a cardiovascular condition but it is essential to rule out potentially serious medical conditions that may be causing heaviness in the chest and throat.

Heaviness in the chest and throat happens when there is constriction in the throat and chest. There may be many causes for this to occur. Some of the causes of a feeling of pressure in the chest and throat are:

Asthma: This is a medical condition in which the airways become narrow and swell as a result of secretion of mucous. This may result in tightness of the chest and throat. Additionally, the individual may find it difficult to breathe in cases of asthma which may further worsen the feeling of pressure in the chest and throat. Once asthma is treated the sensation of heaviness in the chest and throat gradually resolves.

Respiratory System Disorders: This is yet another cause for sensation of pressure in the chest and throat. A respiratory system disorder can be caused due to allergies, inhaling contaminated air, and inhaling toxic chemicals. Bronchitis is the most common respiratory system disorder which tends to cause a sensation of heaviness in the chest and throat.


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