Asthma is one of the common diseases of the respiratory system. It’s a heterogenic disease that can be presented in different ways. The basic condition is to diagnose it correctly since medical studies show that 30-50% of the people who have a physician’s diagnosis of asthma, when they follow the diagnostic algorithm by a pulmonologist, the final result is misdiagnosed. The asthma clinic aims to offer a holistic approach and treatment of the disease based on international guidelines and practices of GINA.
Proper diagnosis of asthma
Asthma is characterized by a chronic inflammation of the airways together with the characteristic symptoms of shortness of breath, chest tightness, cough, wheezing (whistling of breathing). These symptoms may be presented in different ways for each patient and it is important to asses them using a series of diagnostic tests in order to confirm the diagnosis.
For asthma diagnosis, it is important to combine history, clinical examination and Spirometric tests.
Medical History and clinical examination
First, the detailed history of the respiratory system is taken and then a clinical examination takes place. These are the first steps to decide about the appropriate next tests that will substantiate the diagnosis.
Examinations for the measurement of lung function
The next step is the measurements of lung function based on spirometry:
- Spirometry before and after bronchodilation :
If the spirometry that follows after the administration of a bronchodilator inhaled drug, shows significant improvement over spirometry before administration, then the result confirms the diagnosis of asthma.
- Comparison of spirometry after administration of inhaled therapy.
Usually after a period of time when the patient makes systematic use of inhalational treatment with a combination of bronchodilator and inhaled cortisone, if a significant improvement in spirometry is observed, this suggests the diagnosis of asthma.
- Methacholine provocation test: The inhalation of metacholine generally causes a decrease in air flow to the bronchi of asthmatic individuals. The metacholine test is considered to be the most basic test that can confirm or exclude asthma and it is complementary to the other diagnostic tests. In the event of a negative result, asthma is excluded at 98% and this is important because a large proportion of patients diagnosed with asthma was eventually misdiagnosed and had received unnecessary treatment.
- Radiological examination
A chest X-ray can help to identify any structural abnormalities or diseases (such as lower respiratory infection) that may cause or worsen breathing problems.
- Allergy test
Allergy tests can be performed by skin or blood test. In this way we examine the patient’s allergic background on various triggering factors.
- Nitric oxide test. This test measures the amount of nitric oxide gas in your breath. When your airways are inflamed – like in asthma – you may have higher than normal levels of nitric oxide.
- Sputum eosinophils. This test looks for a special type of white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) collected during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored pigment.
- Challenging tests for exercise and asthma caused by cold. In these tests, we estimate the level of obstruction of your airways before and after performing intense physical activity or after inhaling cold air.
1. Target in asthma: Control of the disease
The main goal is the control of asthma which means that the asthmatic person receives the level treatment he/ she needs in order to have a normal life without any activity limitation.
2. How to start and continue treatment
Asthma, has stages of treatment according to severity, where at each stage the pulmonologist decides the combination of treatment. When we achieve asthma control, then we maintain the treatment regimen for at least 3-4 months and then we will reassess the patient and we can reduce the doses of treatment. If for any reason the patient appears again symptomatic, then we increase the dosage (step-up). The most important action is that the patient does not interrupt his treatment for any reason even if there is improvement because there is a possibility of relapse .
3. Proper use of an inhaler device
A very important factor for effective asthma control is the correct use of the inhaler device. The doctor will explain how to correctly use the inhaler devices to get a better result in treatment. At every visit the patient must bring his/ her inhaler devices so as to check whether it is used correctly.
4. Asthma action plan
It is necessary to create an action plan for your asthma that describes in writing when to take certain medications or when to increase or decrease the dose of your medications based on your symptoms. The main parameter for regulating your asthma is to develop a good relationship with your pulmonologist, to contact him whenever needed in order to provide you with immediate advice on your problem.
5. Avoid everything that affects your asthma control
Stop smoking because smoking is one of the main irritants that trigger asthma. Maintain optimum moisture. If you live in a humid climate, talk to your doctor about using a dehumidifier. Prevent fungi. Clean wet areas in the bathroom, kitchen and around the house. Get rid of the numb leaves or wet firewood in the yard. Clean your home at least once a week. If you are likely to be exposed to dust, wear a mask. Wash your bed linen regularly.
Taking care of yourself can help keep your symptoms in control. Having asthma doesn’t mean you have to be less active. Proper treatment will allow you to do any activity you desire without restriction. If you exercise at low temperatures, wear a face mask to warm the air you breathe. Maintain a healthy weight. Being overweight can exacerbate asthma symptoms. Exclude possible gastroesophageal reflux disease (GERD). It is possible that acid reflux causes heartburn and can damage the airways of the lungs and worsen asthma symptoms. If you have frequent or stable heartburn, talk to your doctor about treatment options. You may need treatment for GERD and to contact gastroenterologist .