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Management

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• Diagnosing
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Asthma Management

Diagnosis

The diagnosis of asthma is critical and, due to the similarity of a number of other diseases, asthma can often be misdiagnosed in both adults and children (Table 1)^.1, 2 A diagnosis begins with a medical history, including patterns of symptoms, and a physical examination. Some appropriate questions to aid a diagnosis of asthma are:¹

• Has the patient had an attack or recurrent attacks of wheezing?
• Does the patient have a troublesome cough at night?
• Does the patient wheeze or cough after exercise?
• Does the patient experience wheezing, chest tightness, or cough after exposure to airborne allergens or pollutants?
• Do the patient's colds ‘go to the chest’ or take more than 10 days to clear?
• Are symptoms improved by appropriate asthma treatment? 

A diagnosis should be confirmed with lung function tests.¹ For patients with symptoms consistent with asthma but normal lung function, airway responsiveness can be measured. Non-invasive markers of airway inflammation may also be undertaken and, due to the strong link between asthma and allergic rhinitis, measurements of allergic status can also help with the diagnosis.¹

Diagnosis in children aged ≤5 years

A diagnosis of asthma can be difficult to obtain in young children as episodic wheezing and cough are also common in children who do not have asthma (especially in those <3 years) and it is often not possible to measure airway function to confirm the presence of variable airway obstruction.¹  Therefore, misdiagnoses in young children may be particularly common (Table 1).³

Three categories of wheezing have been described in children aged ≤5 years:¹

• Transient early wheezing: often outgrown in the first 3 years and often associated with prematurity and parental smoking
• Persistent early onset wheezing (before aged 3 years): recurrent episodes of wheezing associated with acute viral respiratory infections, no evidence of atopy and no family history of atopy. Symptoms normally persist through school age and are still present at 12 years of age in a large proportion of children
• Late-onset wheezing/asthma: asthma often persists throughout childhood and into adult life. Patients usually have an atopic background, often with eczema, and airway pathology that is characteristic of asthma.

Frequent episodes of wheeze (>1/month), activity induced cough or wheeze, nocturnal cough in periods without viral infections, absence of seasonal variation in wheeze and symptoms that persist after age 3 years are highly suggestive of a diagnosis of asthma.¹

The presence of wheeze before the age of 3 years, and the presence of one major risk factor (parental history of asthma or eczema), or two of three minor risk factors (eosinophilia, wheezing without colds, and allergic rhinitis), has been shown to predict the presence of asthma in later childhood.¹

ACE=angiotensin-converting enzyme

References:
1. GINA. Global Initiative for Asthma. www.ginasthma.com. 2006.
2. BTS/SIGN. British guideline on the management of asthma. Revised edition. 2005.
3. Bateman E, Balint B, Bodzenta-Lukaszyk A, Hofman J, Valyon E, Vinkler I, et al. Treatment of severe asthma using ciclesonide 160 μg once daily or 320 μg twice daily - a comparison. Proc Am Thoracic Soc 2006;3 (Suppl.)

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