Diagnosing asthma

Welcome back. Today we're going to talk about how asthma is diagnosed. We've talked about signs and symptoms, pathophysiology and etiology, but still haven't answered how one knows when they have asthma, verses a different pulmonary disease. Wheezing, or shortness of breath may also be signs of emphysema, or COPD for example. So, how do we know it's asthma? Well, if you're having difficulty breathing and visit a doctor, he or she will most likely have you do a spirometer test. This measures how much air you can blow out of your lungs and how fast you can do it. The results will be lower than normal, if you're experiencing signs of asthma including inflamed airways, or muscle constriction. You may be given medication, such as an inhaler, to see if this helps improve the spiromter reading. If your spirometer test is normal, but you're still having difficulty breathing, your provider will likely order other tests to find out what is causing the difficulty in breathing.

Here's a good video that shows what a spirometer looks like and how it's used:

In addition to spirometer use, your provider will also look at your medical history noting any family history of asthma and when you experience symptoms, for example after a run, or when exposed to tobacco smoke. He or she will also do a physical exam, looking at your nose and throat and listening to your lung sounds. Crackles, or wheezing are signs of asthma and experiencing these from a trigger such as exercise, or exposure to allergens will also lead the provider to a diagnosis of asthma.

In summary, looking at the medical history, performing a physical exam and using a spirometer are the basics for how asthma is diagnosed. This video gives a more detailed look at how asthma could be diagnosed:

And this website also lays out details on asthma diagnosis:

http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/diagnosis


How Is Asthma Diagnosed? (n.d.). Retrieved January 31, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/diagnosis

Take a deep breath, sit back and relax.

Breath easy. Take a deep breath. Inhale deeply. Breath in and out. All commands we hear daily (especially if you're a yoga fan) that are meant to illicit peace and calmness. But what if you can't? What if the simple act of breathing, one we do millions of times during our lifespan, causes wheezing, chest tightness, and ultimately stress and panic? Someone with asthma, like myself, knows this feeling all too well. We want to take effortless breaths, but can't. But why? Let's take a deeper look into what's going on in the body when someone's experiencing the signs and symptoms of asthma.

As we discussed previously, asthma is characterized by inflammation and narrowing of the airways. In addition to the swelling, increased mucus is secreted that furthers the blockage of air into the lungs. This reaction is usually caused by a trigger or allergen such as pet dander, exercising, or temperature change just to name a few. 

Here's a video that gives a good visual of what's going in your lungs when you're experiencing asthma: 

At the end of the video they give an example of a form of management: a fast acting bronchodilator that helps the swelling to decrease and allows one to take that much needed deep breath. In future blogs we will go into other examples of management and medication options. 

In a publication posted in 2007 about asthma, they discuss airway remodeling. Airway remodeling is a relatively new finding involving asthma in which one's airways actually structurally change. "These structural changes can include thickening of the sub-basement membrane, subepithelial fibrosis, airway smooth muscle hypertrophy and hyperplasia, blood vessel proliferation and dilation, and mucous gland hyperplasia and hypersecretion. Regulation of the repair and remodeling process is not well established, but both the process of repair and its regulation are likely to be key events in explaining the persistent nature of the disease and limitations to a therapeutic response." The publication continues to give information on various studies that have been conducted around determining when and if this permanent change in lung function occurs and what treatment can be administered to prevent it. There was some evidence that showed treating asthma within the first two years of symptom onset can increase long term lung function, although nothing was conclusive and further studies need to be conducted. The full publication which gives details about the pathophysiology of asthma and various studies can be found at: http://www.ncbi.nlm.nih.gov/books/NBK7223/

So, no matter what we know management of asthma is important for quality of life- to breath without even thinking about it. But now there is some evidence that shows management of asthma may also improve long-term lung function and even overall health. 

National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2007 Aug. Section 2, Definition, Pathophysiology and Pathogenesis of Asthma, and Natural History of Asthma.

What's the deal?

Although the management of asthma has greatly improved within the past 50 years, the prevalence has steadily been increasing. Between the years 2001 to 2009 the number of people diagnosed with asthma grew by 4.3 million. In fact, 1 in 12 people in the U.S. now suffer from asthma and the populations most effected are children, females, and minorities. 

The table below shows asthma prevalence, by selected demographic characteristics in the United States, averaged for the years 2008 to 2010.  



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The Center for Disease Control and Prevention gives the most recent data (from 2012) for mortality and morbidity from asthma. Morbidity refers to the rate at which asthma occurs in a group of people and is broken down into rates for adults and rates for children. For adults the number of non-institutionalized adults who currently have asthma is 18.7 million, or 8.0% of the population. The number of children who currently have asthma is 6.8 million, or 9.3%. The mortality rate refers to how many people have died from asthma and in 2011 the number of deaths were 3,345, or 1.1 out of 100,000. These numbers lead to questions of why. Why is the incidence greater in children? Why do the number of people with asthma continue to increase? Why do we not know the cause, or ways to prevent someone from getting asthma? Why is there not a cure? For a disease so common and well known, the underlying questions cannot currently be answered. But the question we can answer is: how do we manage the symptoms of asthma in a cost-effective way? 

Now, as with most things, the discussion of asthma prevalence leads to another question, the big cha-ching question: how much is this costing? If we look at the statistics for asthma related visits to the ER (1.8 million in 2010) and hospital stays with asthma as the primary diagnosis (439,000 with an average stay of 3.6 days) we can see how important education and access to management of the disease is. Not only does living with uncontrolled asthma lead to a lower quality of life (caused by trouble breathing and constant inflammation in your body), but it ultimately costs more in the long run when people are forced to make emergency visits. In the U.S. asthma cost $56 billion in 2007 due to medical costs, lost school and work days, and early deaths. In one article they found "the most cost-effective enhanced management was a mixture of education and self-management by an integrated team of healthcare and allied healthcare professionals". Another study also found that the use of medications that decrease inflammation (inhaled corticosteroids) and reduce the risk of asthma attacks and need for hospitalization is sometimes more expensive and less easy to obtain than inhalents that offer quick symptom relief (β2 agonist). People may use the quick solution and therefore not seek out further help from a health care team, leading to poorly managed asthma and increased risk for big ticket items (both financially and health wise)- such as asthma attacks, ER visits, or even death.  

So, the take away message remains: the importance of well managed asthma cannot be overlooked and is critical for quality of life and quality of bank accounts. 

                                                   


Asthma in the US. (2011, May 3). Retrieved January 17, 2015, from http://www.cdc.gov/vitalsigns/Asthma/?s_cid=vitalsigns_065

Trends in Asthma Prevalence, Health Care Use, and Mortality in the United States, 2001–2010. (2012, May 1). Retrieved January 17, 2015, from http://www.cdc.gov/nchs/data/databriefs/db94.htm#x2013;2010

Asthma. (2014, July 14). Retrieved January 17, 2015, from http://www.cdc.gov/nchs/fastats/asthma.htm

Yong, Y., & Shafie, A. (n.d.). Economic evaluation of enhanced asthma management: A systematic review. Retrieved January 17, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282768/

Chiang, Aït-Khaled, Bissell, & Enarson. (n.d.). Management of asthma in resource-limited settings: Role of low-cost corticosteroid/β-agonist combination inhaler. Retrieved January 17, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/25574908

What is asthma?

Most of us have heard of asthma and understand that it's a condition that makes breathing difficult. However, the intention of this blog is to give a better understanding of what goes on in your body when you have asthma and to discuss how millions of people are living an active and healthy life with the disease. 

Let's start by defining asthma. Asthma is a condition that causes the airways of the lungs to swell, narrow and secrete mucus, leading to shortness of breath, wheezing, and coughing. This reaction is often triggered by an allergen, or other stimuli such as temperature change or exercise. The condition is chronic (meaning it will last a long time, if not for the rest of one's life), but many options exist to help people manage the symptoms. Asthma varies in severity from person to person and can change throughout one’s life, so it’s important to stay connected to a provider who can help you track your asthma. It isn’t entirely known why some people develop asthma, but it’s presumed to be a combination of genetic and environmental factors. Some people have asthma consistently, some only when exercising, and some very infrequently. Different medications and dosages exist to help you maintain the best quality of life and breath.  

Historically, asthma was not understood to be an inflammatory disease caused by a sensitive immune system reacting to a trigger. It wasn't until the 1960's that this breakthrough was discovered and the first inhaled anti-inflammatory medication was born. So, although the Piggy (Lord of the Flies anyone,anyone?) of yesteryears could not go out for a swim because of his ill-fated "assmar", the Piggy of today can splash around to his heart's content. 

As Buster Baxter (Arthur anyone, anyone?) states: "I have asthma and it's okay" .........Asthma Rap