At The Specialist Asthma Clinic
If youre taking your asthma medicines exactly as prescribed and using the right inhaler technique, but youre still getting symptoms, your GP or asthma nurse may refer you to a specialist asthma clinic. It may take some time before you get an appointment, so youll still have to manage your condition through your GP until then.
At the clinic they will try to work out whats going on by answering these questions:
- Is the type of asthma you have difficult to control asthma?
- Is the type of asthma you have severe asthma?
- Is there another reason why youre getting your asthma symptoms?
You might have had tests to diagnose and monitor your asthma already, but to confirm or rule out a diagnosis of severe asthma you may need some extra tests.
You probably wont need all these tests, though. Your asthma specialist will explain which ones you need and why.
Everyone with asthma is different so the tests youll need will depend on your individual asthma symptoms, medical history, family history and any other conditions you have, says Asthma UKs in-house GP Dr Andy Whittamore.
And because your asthma symptoms can vary over time, you may need to have these tests more than once to help your asthma specialist make the right diagnosis.
Test Used To Diagnose Asthma May Not Be Accurate
by Wiley
A new study urges caution in the use of the mannitol challenge test for asthma in non-clinical settings. The test is considered widely applicable to detect asthma, but its accuracy outside of patients referred for specialized respiratory has not been thoroughly explored before.
The mannitol challenge test is a cost-effective and easily applied test to detect if the airways are more likely to contract or narrow more than normal. These airway reactions are associated with asthma and airway inflammation.
In the 772-participant Respirology study, the test results were as expected in people who reported wheezing, but it had a relatively low predictive value for asthma in the general population. This means that within the general population, a positive test result could not reliably detect asthma.
“The mannitol challenge test is increasingly used to screen for asthma in groups such as defence force recruits, athletes, and asymptomatic young people participating in sports. Our study highlights the need for caution when interpreting results of this test in non-clinical populations,” said Dr. Graham Hall, senior author of the study.
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Use Clinical Tests To Diagnose Asthma And To Avoid Overdiagnosis Says Nice
Doctors should use clinical tests to accurately diagnose asthma rather than simply taking a medical history, the National Institute for Health and Care Excellence has said, because around 1.2 million UK adults may be wrongly receiving treatment for the condition.
No gold standard test is currently available to diagnose asthma, and in current practice doctors mainly check for signs and symptoms. But NICE said that almost a third of people being treated for asthma do not have clear evidence of the condition. Some may have had asthma in the past, NICE added, but
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Are There Different Tests To Diagnose Asthma In Children
Children under 5 years old dont normally have lung function tests. Instead, a doctor will do a physical exam and make note of all their symptoms. Theyll collect a detailed medical history and will ask questions about the family medical history.
There are many conditions that might look like asthma in young children, making diagnosis difficult. Your childs doctor might prescribe an inhaled medication called a bronchodilator. This medication is safe and temporarily opens the airways.
It might be a sign your child has asthma if the bronchodilator improves their breathing symptoms. Your childs doctor will make a diagnosis once there is enough evidence to support that asthma is causing your childs breathing difficulties.
Depression And Anxiety Scores
These questionnaires are used to find out how having severe asthma is affecting you emotionally. In an Asthma UK survey, 68% of people with severe asthma said theyd had anxiety and 52% of people with severe asthma said they felt depressed.
Because asthma symptoms that affect your quality of life can be worrying and get you down, its important for your healthcare team to understand how youre feeling, says Dr Andy.
If youre seeing an asthma specialist to diagnose or rule out severe asthma, they will usually consider screening you for anxiety and depression often using these questionnaires. For some people with asthma, treating the depression and anxiety can have a big impact on your symptoms and how they affect you.
Evidence shows that people with low mood or anxiety can find it harder to control their asthma symptoms, says Dr Andy. Its important that your asthma specialist and healthcare team have a good understanding of how youre feeling so they can give you the support you need.
Next review due March 2022
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Respiratory Assessment At The Primary Care Diagnostic Center
At their first visit, spirometry was performed with bronchodilator responsiveness according to ATS/ERS standard procedures. All patients who underwent spirometry were asked to complete a structured questionnaire covering relevant clinical information , including the ACQ, and the consulting pulmonologist or GP is provided with these details and the spirometry results. Diagnostic assessment was then reported on a standardized protocol , though comments could be added if necessary, and the requesting GP was given a report of the assessment. Wherever possible, a working diagnosis and therapeutic or diagnostic recommendations were given without seeing the patient. The following working diagnoses were given based on the spirometry results: asthma, COPD, no airway obstruction, combined asthma and COPD, probable asthma, possible asthma, possible restriction, and patient could not perform test . Probable asthma referred to patients with a typical history of asthma, but whose spirometry results were not diagnostic. Possible asthma referred to patients without a typical history of asthma, but whose spirometry results and symptoms suggested that asthma remained possible .
Fig. 2: Questionnaire items and structure of the PFT assessment.
a Items on questionnaire before spirometry. b Format for structured PFT assessment. ACQ Asthma Control Questionnaire, COPD Control Questionnaire, ACO asthma/COPD overlap, FEV1 forced expiratory volume in 1s.
Response From Lyn Harper Mpa Bsrt Rrt
First was a thorough physical exam that included a detailed medical history. This included all the times I had symptoms, however minor. Where I was, what I was doing, and how long it lasted. Second was a full pulmonary function test or PFT. The results are broken into three categories Normal, Obstructive, and Restrictive. Asthma is considered an obstructive airway disease. Allergy testing was next as it had become fairly apparent that I had allergy induced asthma.
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Symptom And Quality Of Life Scores
These tests involve filling out questionnaires to find out what symptoms youre experiencing and the different ways asthma may be affecting your life.
In an Asthma UK survey, 91% of people said their severe asthma had an impact on everyday things, such as their ability to exercise, their family and social life, their work or school life and their holidays. In the same survey 82% of people said theyd experienced sleep loss and 66% had gained weight.
If your asthma symptoms mean you cant do things you used to be able to do, such as exercise or play with your children, these scores will help your asthma specialist find out how asthma is affecting your life, says Dr Andy. Theyre also a useful way to monitor how well your asthma treatments are working.
Asthma specialists use these tests to:
- give them a clearer picture of your asthma symptoms
- show them how asthma may be limiting your activities
- reveal how youre coping with the challenges of having frequent asthma symptoms
- work out your response to longer-term treatment trials.
What To Expect When Having A Chest X
X-rays are usually taken by a trained and certified radiology technician. Patients who are undergoing an X-ray of the chest will put on a special gown and remove all metallic items, including jewelry so that they don’t block the X-ray beam from penetrating the body.
The X-ray technician may ask the patient to inhale deeply and hold her breath during the procedure to inflate the lungs and make the various chest tissues more visible. X-rays may be taken from the front, back and side views, and from different camera angles while sitting, standing or lying down.
Once the X-ray has been taken, the exposed film is placed into a developing machine and the image is examined and interpreted by a radiologist . After the radiologist reviews the X-ray, he or she will send a report to the doctor who ordered the test. This doctor will then discuss the results and recommended treatment options with the patient.
The risks of chest X-rays are minimal, especially because today’s high-speed film does not require as much radiation exposure as the type of film used years ago. However, any exposure to radiation has some risk, which is why the technician asks the patient to wear a lead apron over the reproductive parts of the body or the extremities to shield from exposure. Pregnant women should ask their physicians before having an X-ray taken, as this could harm the fetus.
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Response From Theresa Cannizzarro Respiratory Therapist
Along with a detailed medical history and physical exam, the test that is done to give the official asthma diagnosis is a Lung Function Test, which is also called a Pulmonary Function Test or PFT. This is the test where you wear the little nose clips to plug your nose and blow into a mouthpiece that is attached to a machine and you are coached by a respiratory therapist how to do different breathing maneuvers. The most common maneuver is the spirometry where you take a deep breath in and blow out hard & fast like you are blowing out an entire birthday cake full of candles. This specific maneuver and result is important in diagnosing asthma along with your medical history etc.
Feasibility Safety And Diagnostic Value
A feasibility analysis was conducted in which we retrospectively looked at the number of referrals, the correct indication of these referrals, the number of BCTs carried out per year, and the quality of BCTs during the studied 5-year period.
To analyze patients with a high probability of asthma, we only included patients who performed a spirometry test at our diagnostic center before undergoing BCT: the final cohort. This improved the chance of obtaining consistent high-quality baseline spirometry results and working diagnoses based on expert assessment. Furthermore, BCT was usually advised by the expert assessor, so the indication for the test was assumed to be correct. Patients labeled as probable or possible asthma were included because these had a high pretest probability of asthma. We calculated how often BCT was positive, thereby confirming the diagnosis of asthma.
Finally, we assessed the safety of BCT in the primary care diagnostic center by looking at the adverse events during the test and that were reported back to us after performing the test.
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Types Of Lung Function Tests
Lung function tests are often done before and after inhaling a medicine known as a bronchodilator , which opens your airways. If your lung function improves a lot after a bronchodilator, you probably have asthma.
Most lung function tests require you to exhale or inhale using a device or a mouthpiece connected to a device. They are simple tests that are often done in the doctors office. Your doctor may ask you to stop taking certain medicines before your appointment.
Spirometry. This is the recommended test to confirm asthma. During this test, you breathe into a mouthpiece thats connected to a device, called a spirometer, or to a laptop. It measures the amount of air youre able to breathe in and out and its rate of flow. You will take a deep breath and then exhale forcefully.
Peak flow meter. This test uses a peak flow meter. Its a small, handheld device that you breathe into to measure the rate at which you can force air out of your lungs. During the test, you breathe in as deeply as you can and then blow into the device as hard and fast as possible. If youre diagnosed with asthma, you can use a peak flow meter at home to help track your condition. But a peak flow meter cannot be used to diagnose asthma.
These lung function tests are some of the most common types used. There are also other types of lung function tests your doctor may use to diagnose and manage your asthma, depending on age, symptoms, medical history and more.
How Do I Prepare For A Lung Function Test
Before your appointment, ask your doctor if thereâs anything you need to do to prepare for spirometry.
Before taking a methacholine challenge test, let your doctor know if you recently had a viral infection, such as a cold, or any shots or immunizations, since these might affect the test results.
Other things to do on the day of a lung function test:
- Donât smoke
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Mannitol Challenge Test Used To Diagnose Asthma May Not Be Accurate
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The mannitol challenge test is a cost-effective and easily applied test to detect if the airways are more likely to contract or narrow more than normal. These airway reactions are associated with asthma and airway inflammation. A new study urges caution in the use of the mannitol challenge test for asthma in non-clinical settings. The test is considered widely applicable to detect asthma, but its accuracy outside of patients referred for specialized respiratory management has not been thoroughly explored before.
Respirology
How Are Spirometry Results Used
To diagnose asthma: Having a low FEV1 and low FEV1/FVC means that the air has a hard time leaving the lungs, which indicates airway obstruction. Obstructive lung diseases include asthma and COPD .
The results after taking albuterol help separate asthma from COPD. If FEV1 increases by 12% or 200 mL after taking albuterol, it means that the airway blockage is reversible.1 Reversibility is a sign of asthma.
To figure out how severe asthma is: The results of spirometry indicate how severe your asthma is, as shown in Table 2.1
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Study Population And Study Design
For this study, we re-analysed data from a clinical study performed in 20072008 in Switzerland. It included consecutive first-time referrals to the respiratory outpatient clinics of two paediatric hospitals of 616-year-old children for evaluation of a possible asthma diagnosis with a history of wheezing, dyspnoea or cough. Children were excluded from the study if they had a known chronic respiratory disease such as cystic fibrosis, or a respiratory tract infection during the 4 weeks prior to the visit. The aim of the initial study had been to compare the results of mannitol challenge tests to exercise challenge tests .
Characteristics Of The Study Population
Of the 124 children invited, 111 were recruited, 84 from St Gallen and 27 from Basel. The median age was 12 years and 62% were male. Most children were referred with wheeze and cough or wheeze without cough . Inhaled medication had been used by 64% prior to referral, including 19% who had used inhaled corticosteroids . Of the 111 participants, 80 were diagnosed with asthma after all BPTs were done compared to 94 before the BPTs. The remaining children were diagnosed with cough unrelated to asthma and with inducible laryngeal obstruction and dysfunctional breathing . None of the children were diagnosed with a severe lung disease such as cystic fibrosis .
Receiver operating characteristic curve of clinical tests to diagnose asthma. Test : skin-prick test number positive SPT cumulative wheal size exhaled nitric oxide fraction forced expiratory volume in 1s FEV1/forced vital capacity bronchodilator reversibility exercise methacholine mannitol . #: cut-off with maximum combined sensitivity and specificity.
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Fractional Exhaled Nitric Oxide
Fractional exhaled nitric oxide testing detects and measures a gas produced by cells in the airways when they are inflamed as a result of allergic or eosinophilic asthma. The presence of this gas, nitric oxide, can help diagnose asthma or determine how well anti-inflammatory medicationsâtypically inhaled corticosteroids âare controlling asthma.
The test is simple and noninvasive: It involves exhaling slowing and steadily into a handheld instrument. The device measures the amount of nitric oxide in the breath in parts per billion . FeNO takes place in a doctor’s office and the results of the test are available immediately.
FeNo testing was one focus of a National Institutes of Health panel of experts who issued updated guidelines for asthma management in December 2020. According to their recommendations, FeNO testing should not be used alone to diagnose or monitor asthma, but can be helpful as an add-on test when a person’s symptoms and spirometry and other tests aren’t conclusive.
The guidelines apply only to adults and children 5 and over. The panel advised against FeNO testing for younger children as a way to assess wheezing, as studies show it to be an unreliable way to predict if they ultimately will develop asthma.
Other Tests You May Need If You Have Asthma
Even if your lung function tests are normal, your doctor may order other tests to see what could be causing your asthma symptoms.
- Gas and diffusion tests can measure how well your blood absorbs oxygen and other gases from the air you breathe. You breathe in a small amount of a gas, hold your breath, then blow out. The gas you exhale is analyzed to see how much your blood has absorbed.
- X-rays may tell if there are any other problems with your lungs, or if asthma is causing your symptoms. High-energy radiation creates a picture of your lungs. You may be asked to briefly hold your breath while you stand in front of the X-ray machine.
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