How to Diagnose Bronchial Asthma in Adults?

The diagnosis of bronchial asthma in adults generally depends on the clinical history (symptoms) and examination (signs) in the absence of an alternative explanation for them. Initial diagnosis of asthma can be made on a thorough clinical assessment and a measurement of airflow obstruction. It is recommended to perform spirometry as the initial test to evaluate the existence and intensity of airflow obstruction. Some symptoms and signs raise the probability of asthma while some reduce.


Symptoms and signs, which raise the probability of bronchial asthma.

• If a person has more than one of the following symptoms, his or her probability of bronchial asthma is high. Especially, if the symptoms are more serious in the early morning and at night; worse following, or appear in response to, cold air, allergen exposure, exposure to pets, emotions, taking medications like β blockers or Aspirin, and exercise.

• Symptoms are:

• Cough
• Wheezing
• Chest tightness
• Shortness of breath

• Clinical history of atopic disease

• Family history of atopic disease and/or bronchial asthma

• Wide-spread sound of wheezing heard on auscultation by a doctor

• Otherwise unexplained eosinophilia in blood

• Otherwise unexplained low Peak Expiratory Flow (PEF) or Forced Expiratory Volume in one second (FEV1)

Symptoms and signs, which lower the probability of bronchial asthma.

• Symptoms with cold only

• Features of cardiac disease

• Marked light-headedness, dizziness, tingling feet or hands

• Voice disturbance

• Persistent (chronic) productive cough without shortness of breath or wheezing

• Continuously normal chest examination, when the person is symptomatic.

• Significant history of smoking such as more than 20 pack-years

• Repeatedly normal spirometry/spirogram or PEF, when the person is symptomatic.

According to the clinical evaluation, patients can be categorised into three groups.

Patients with a high probability of bronchial asthma
Individuals with a high probability of asthma should be offered a trial of asthma treatment. If the response to a trial of medication is poor, further testing is needed.

Patients with an intermediate probability of bronchial asthma
People with an intermediate probability should be offered further testing, including a specific trial of medication for a particular period, before verifying the asthma diagnosis and setting up maintenance medication.

Patients with a low probability of bronchial asthma
In this category, the diagnosis rather than asthma is likely. Therefore, these patients should be investigated further and managed appropriately. If the response to management is poor, the diagnosis of bronchial asthma should be reconsidered.



Related Links:

How to Diagnose Bronchial Asthma in Children?
Prevention of Bronchial Asthma
Basics of Pharmacological Management of Asthma
Bronchial Asthma: Stepwise Management in Adults
How to Diagnose Acute Asthma in Adults?
How to Manage Acute Asthma in Adults?