The flare-ups affect activity level. Night time symptoms occur between 3-4 times a month. FEV1 is atleast 80 % of normal values. Peak flow variability is 20-30 percent (SIGN, 2009). In moderate persistent asthma, the symptoms occur daily and the flare-ups affect activity levels. Night time symptoms occur atleast 5 times a month. The FEV1 values are between 60% and 80% (SIGN, 2009). The peak flow variability is more than 30%. In severe persistent asthma, the symptoms are continual. Night time symptoms occur frequently. FEV1 is less than 60% and peak flow variability is more than 30% (SIGN, 2009). Methods of diagnosing asthma To arrive at a diagnosis of asthma, physicians must establish episodic airflow obstruction symptoms which are reversible and alternative diagnoses must be excluded (Morris, 2014).
There are no specific tests to arrive at a diagnosis of asthma. Pulmonary function tests are useful to monitor response to treatment (Morris, 2014). Diagnosis of asthma in adults is based on the recognition of certain characteristic patterns of signs and symptoms and absence of alternative explanation for the clinical presentation (NAEPP, 2007).
The diagnosis is mainly based on clinical presentation (NAEPP, 2007). Thus careful history taking is essential to establish the diagnosis. Clinical features which favor the diagnosis of asthma are presence of more than one of these symptoms: breathlessness, wheezing, cough and chest tightness, especially if the symptoms are worse in early mornings or nights, if the symptoms are exacerbated in response to exposure to allergens, cold air or following exercise, and if symptoms occur after taking medications like beta blockers or aspirin (SIGN, 2009).
Other clinical features which favor the diagnosis of asthma are history of atopy, family history of atopy or asthma, wide spread rhonchi of chest auscultation and otherwise unexplained aspects like raised peripheral blood eosinophils, low PEF and low FEV1 (SIGN, 2009). Certain clinical features indicate low probability of asthma and these are presence of light headedness, dizziness, peripheral tingling, chronic productive cause without wheezing or breathlessness, normal auscultatory findings of the chest when symptomatic, disturbances in voice, presence of symptoms only following colds, chronic history of cigarette smoking, presence of cardiac disease and recording of normal spirometry when symptomatic (SIGN, 2009).
The initial diagnosis should be based on careful assessments of the clinical symptomatology and measurement of obstruction of the airflow.
Bateman, E.D., Hurd, S.S., Barnes, P.J., Bousquet, J., Drazen, J.M., FitzGerald, M., et al. (2008). Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J., 31(1),143-78.
Busse, W.W., Calhoun, W.F., Sedgwick, J.D. (1993) Mechanism of airway inflammation in asthma. American Review Respiratory Diseases, 147(6 Pt 2), S20-4.
Expert Panel Report 3 (EPR-3) (2007): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol., 120(5 Suppl):S94-138
Hamilos, D.L. (1995) Gastroesophageal reflux and sinusitis in asthma. Clinics of Chest Medicine, 16(4), 683-97.
Ignacio-Garcia, J.M., Gonzalez-Santos, P. (1995) Asthma self-management education program by home monitoring of peak expiratory flow. American Journal Respiratory and Critical Care Medicine, 151(2 Pt 1), 353-9.
Morris, M.J. (2014). Asthma. Medscape. Retrieved on 27th April, 2014 from http://emedicine.medscape.com/article/296301-overview
National Asthma Education and Prevention Program or NAEPP. (2007) Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. NIH Publication No. 07-4051.
Nair, P., Pizzichini, M.M., Kjarsgaard, M., et al. (2009) Mepolizumab for prednisone-dependent asthma with sputum eosinophilia. New England Journal of Medicine, 360(10), 985-93.
Nayak, A. (2004) A review of montelukast in the treatment of asthma and allergic rhinitis. Expert Opinion in Pharmacotherapy, 5(3), 679-86.
OByrne, P.M., Parameswaran, K. (2006) Pharmacological management of mild or moderate persistent asthma. Lancet, 368(9537), 794-803
Rowe, B.H., Edmonds, M.L., Spooner, C.H., Diner, B., Camargo, C.A. Jr. (2004) Corticosteroid therapy for acute asthma. Respiratory Medicine, 98(4), 275-84.
Scottish Intercollegiate Guidelines Network. (SIGN). (2009) British Guideline on the Management of Asthma. Retrieved on 26th April, 2014 www.sign.ac.uk/guidelines/fulltext/101/index.html
Williams, S.G., Schmidt, D.K., Redd, S.C., Storms, W. (2003) Key clinical activities for quality asthma care. Recommendations of the National Asthma Education and Prevention Program. Morbidity and Mortality Weekly Report Recommendations and Reports, 52, 1-8.