Complications
Asthma may cause a number of complications, including:
- Symptoms that interfere with sleep, work or recreational activities
- Sick days from work or school during asthma flare-ups
- Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe
- Emergency room visits and hospitalizations for severe asthma attacks
- Side effects from long-term use of some medications used to stabilize severe asthma
Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. However, when you call to set up an appointment, you may be referred immediately to an allergist, pulmonologist or other specialist.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
These steps can help you make the most of your appointment:
- Write down any symptoms you're having, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Note when your symptoms bother you most — for example, if your symptoms tend to get worse at certain times of the day; during certain seasons; or when you're exposed to cold air, pollen or other triggers.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For asthma, some basic questions to ask your doctor include:
- Is asthma the most likely cause of my breathing problems?
- Other than the most likely cause, what are other possible causes for my symptoms?
- What kinds of tests do I need?
- Is my condition likely temporary or chronic?
- What's the best treatment?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- What exactly are your symptoms?
- When did you first notice your symptoms?
- How severe are your symptoms?
- Do you have breathing problems most of the time, or only at certain times or in certain situations?
- Do you have allergies, such as atopic dermatitis or hay fever?
- What, if anything, appears to worsen your symptoms?
- What, if anything, seems to improve your symptoms?
- Do allergies or asthma run in your family?
- Do you have any chronic health problems?
Tests and diagnosis
Diagnosing asthma can be difficult. Signs and symptoms can range from mild to severe and are often similar to those of other conditions, including emphysema, early congestive heart failure or vocal cord problems. Children often develop temporary breathing conditions that have symptoms similar to asthma. For example, it can be hard to tell asthma from wheezy bronchitis, pneumonia or reactive airway disease.
In order to rule out other possible conditions, your doctor will do a physical exam and ask you questions about your signs and symptoms and about any other health problems. You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe.
Tests to measure lung function include:
- Spirometry. This test measures the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
- Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and deal with low peak flow readings.
Lung function tests often are done before and after taking a bronchodilator (brong-koh-DIE-lay-tur) such as albuterol to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma.
Other tests to diagnose asthma include:
- Methacholine challenge. If you have asthma, inhaling a known asthma trigger called methacholine will cause mild constriction of your airways. If you react to the trigger, you likely have asthma. This test may be used if your initial lung function test is normal.
- Nitric oxide test. This test is sometimes used to diagnose and monitor asthma. It measures the amount of a gas called nitric oxide you have in your breath. If your airways are inflamed — a sign of asthma — you may have higher than normal nitric oxide levels. This test isn't widely available.
How asthma is classified
To classify your asthma severity, your doctor will consider your answers to questions about symptoms (such as how often you have asthma attacks and how bad they are), along with the results of your physical exam and diagnostic tests. Determining the severity level of your asthma will help your doctor choose the best treatment for you. Asthma severity often changes over time, requiring an adjustment to treatment.
Asthma is classified into four general categories:
| Asthma classification | Signs and symptoms |
|---|---|
| Mild intermittent | Mild symptoms up to two days a week and up to two nights a month |
| Mild persistent | Symptoms more than twice a week, but no more than once in a single day |
| Moderate persistent | Symptoms once a day and more than one night a week |
| Severe persistent | Symptoms throughout the day on most days and frequently at night |
