How to Diagnose Asthma? What are the Treatments?

An allergist can diagnose asthma by checking a patient’s medical history and perform a breathing test to verify how your lungs work. Below are a few tests that help doctors to diagnose asthma (1).

How to Diagnose Asthma?

1. Spirometry

Spirometry is a safe and painless breathing test used to check the functioning of your lungs. This test measures the quantity of air you can inhale and exhale from your lungs and how fast you can blow out air from your lungs. It helps the doctor analyze whether the signs of lung disease get better or worse and if the prescribed medicines help control breathing problems. The doctor should know in advance of your medical history if you have a recent heart attack, abdominal, chest, or eye surgery, collapsed lung, or tuberculosis. A day before the test – The doctor will suggest if you need to stop inhalers or medications. Also, avoid intake of a heavy meal, which helps take a deep breath. On the day of the test – You will sit straight, and the clip is put on your nose. Take a deep breath and blow as fast as you can into a plastic mouthpiece connected to a spirometer. As you blow hard, you may feel like coughing, dizziness, or lightheadedness. If you feel any discomfort, let the technician know. This procedure is performed at least 3 times for accurate results, and the machine will calculate and graph the results. After the test – A drug will be prescribed to open your lungs, and the test will be repeated to verify whether the medication has improved breathing measurements. The doctor will brief you on the test results.

2. Feno Test

Eosinophilic asthma or allergic patients undergo this test to determine how much lung inflammation is present and how inhaled steroids suppress the inflammation. It is otherwise called the exhaled nitric oxide test. Patients may feel their breathing is normal; when the exhaled nitric oxide is measured, it might be elevated. So usage of inhaled steroids suppresses inflammation, which helps you to do better in the long term.

3. Measurement of Nitric Oxide

Nitric oxide gas is generated by cells involved in the inflammation caused by allergic or eosinophilic asthma. FeNO test is done using a portable device that measures nitric oxide level in PPB (parts per billion). This test describes the fractional concentration of exhaled nitric oxide from the air exhaled gently from your lungs (2). It is different from other lung tests; to get the exact measurement, you must blow air slowly and steadily. The exhaled nitric oxide level helps allergists verify if the inflammation is caused by allergic or eosinophilic asthma. Then nitric oxide level is rechecked to make sure the steroid inhalers suppress the nitric oxide level. The allergist uses data from the FeNO test, spirometry, and other lung tests to adjust medications to keep your asthma in check.

4. Allergy Testing

This test can identify which allergen causes allergy to a person. You can find a detailed explanation here.

5. Physical Exam

The main focus areas are the chest, upper respiratory tract, and skin. The doctor will listen for signs of wheezing, that may indicate asthma and airways block (3). They also check for,

• Running nose
• Swelling of nasal passages
• Any growth on the inside of the nose
• The skin for signs of hives or eczema

Treatment

Depending on the type of asthma, your age and your trigger treatments may vary.

1. Breathing Exercise

It helps to get more air in and out of the lungs, which increases lung capacity. These exercises also minimize severe asthma symptoms.

2. Rapid Relief Medications

Bronchodilators – Relax the tightened muscles around lung airways within minutes. Intake is through either inhaler or nebulizer (4). It contains albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex, Xopenex HFA). Anticholinergic Agents – Ipratropium (Atrovent HFA) and Tiotropium (Spiriva, Spiriva Respimat) help breathe easily by relaxing your airways. It is used to treat emphysema and chronic bronchitis but also can be used for asthma treatment. Oral and Intravenous Corticosteroids – Prednisone (Prednisone Intensol, Rayos) and Methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol) drugs relieve inflammation in airways caused by severe asthma. When used for the long term, it will have severe side effects. Severe asthma will be treated for a short time with these drugs for relaxing airways.

3. Medications for the Longer Term

These medications can be taken regularly, which aids in reducing the severity of your asthma symptoms (5). However, they don’t manage the sudden signs of an attack. Inhaled Corticosteroids – It needs several days to weeks to reach its benefit. However, inhaled corticosteroids have lesser side effects than oral corticosteroids (6). These medications contain,

• Fluticasone Propionate (Flovent Diskus, Flovent HFA, Xhance)
• Budesonide (Pulmicort Respules, Pulmicort Flexhaler, Rhinocort)
• Ciclesonide (Alvesco)
• Beclomethasone (Ovar Redihaler)
• Mometasone (Asmanex Twisthaler, Asmanex HFA)
• Fluticasone Furoate (Arnuity Ellipta)

Combination Inhalers – It consists of a long-acting beta-agonist along with a corticosteroid. Combined medications include,

• Budesonide-Formoterol (Symbicort)
• Formoterol-Mometasone (Dulera)
• Fluticasone-Salmeterol (Advair HFA, Airduo Digihaler, Others)
• Fluticasone Furoate-Vilanterol (Breo Ellipta)

Leukotriene Modifiers – Relieves asthma signs. Drugs include,

• Zafirlukast (Accolate)
• Montelukast (Singulair)
• Zileuton (Zyflo)

Montelukast shows psychological reactions like aggression, hallucinations, agitation, depression, and suicidal thinking. Be cautious and consult your doctor before intake. Theophylline – It is a regular pill that helps to keep lung airways open for easy breathing. Theophylline (Theo-24, Elixophyllin, Theochron) usage needs routine blood tests and is not used often, unlike other asthma medications. Biological Therapy Drugs – It is a new injectable medication, which helps severe asthma people.

4. Bronchial Thermoplasty

An electrode is used to heat the airways inside the lungs, which reduces the muscle size and prevents it from tightening. Though it is not available widely, it is helpful for severe asthma cases.