Diagnosis - Asthma - How Is Asthma Diagnosed?
Your primary care doctor will diagnose asthma based on your medical and family histories, a physical exam, and test results.
Your doctor also will figure out the severity of your asthma—that is, whether it's intermittent, mild, moderate, or severe. The level of severity will determine what treatment you'll start on.
You may need to see an asthma specialist if:
- You need special tests to help diagnose asthma
- You've had a life-threatening asthma attack
- You need more than one kind of medicine or higher doses of medicine to control your asthma, or if you have overall problems getting your asthma well controlled
- You're thinking about getting allergy treatments
Medical and Family Histories
Your doctor may ask about your family history of asthma and allergies. He or she also may ask whether you have asthma symptoms and when and how often they occur.
Let your doctor know whether your symptoms seem to happen only during certain times of the year or in certain places, or if they get worse at night.
Your doctor also may want to know what factors seem to trigger your symptoms or worsen them. For more information about possible asthma triggers, go to "What Are the Signs and Symptoms of Asthma?"
Your doctor may ask you about related health conditions that can interfere with asthma management. These conditions include a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea.
Your doctor will listen to your breathing and look for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, and allergic skin conditions, such as eczema.
Keep in mind that you can still have asthma even if you don't have these signs on the day that your doctor examines you.
Pulmonary Function Tests
Your doctor will use pulmonary function tests to check how your lungs are working.
- Spirometry measures how much air you can breathe in and out. It also measures how fast you can blow air out.
- Bronchoprovocation tests measure how your airways react to specific exposures. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in. Fractional concentration of exhaled nitric oxide tests measure how much nitric oxide is in the air you exhale. This test can be helpful to diagnose or guide asthma treatment in some patients.
Your doctor also may give you medicine and then test you again to see whether the results have improved.
If the starting results are lower than normal and improve with the medicine, and if your medical history shows a pattern of asthma symptoms, your diagnosis will likely be asthma.
Your doctor may recommend other tests if he or she needs more information to make a diagnosis. Other tests may include:
- Allergy testing to find out which allergens affect you, if any.
- A test to measure how sensitive your airways are. This is called a bronchoprovocation (brong-KO-prav-eh-KA-shun) test. Using spirometry, this test repeatedly measures your lung function during physical activity or after you receive increasing doses of cold air or a special chemical to breathe in.
- A test to show whether you have another condition with the same symptoms as asthma, such as reflux disease, vocal cord dysfunction, or sleep apnea.
- A chest X-ray or an EKG (electrocardiogram). These tests will help find out whether a foreign object or other disease may be causing your symptoms.
Diagnosing Asthma in Young Children
Most children who have asthma develop their first symptoms before 5 years of age. However, asthma in young children (aged 0 to 5 years) can be hard to diagnose.
Sometimes it's hard to tell whether a child has asthma or another childhood condition. This is because the symptoms of asthma also occur with other conditions.
Also, many young children who wheeze when they get colds or respiratory infections don't go on to have asthma after they're 6 years old.
A child may wheeze because he or she has small airways that become even narrower during colds or respiratory infections. The airways grow as the child grows older, so wheezing no longer occurs when the child gets colds.
A young child who has frequent wheezing with colds or respiratory infections is more likely to have asthma if:
- One or both parents have asthma
- The child has signs of allergies, including the allergic skin condition eczema
- The child has allergic reactions to pollens or other airborne allergens
- The child wheezes even when he or she doesn't have a cold or other infection
The most certain way to diagnose asthma is with a pulmonary function test (spirometry), a medical history, and a physical exam. However, it's hard to do pulmonary function tests in children younger than 5 years. Thus, doctors must rely on children's medical histories, signs and symptoms, and physical exams to make a diagnosis.
Doctors also may use a four- to six-week trial of asthma medicines to see how well a child responds.