Diagnosis of Asthma

If we determine that you or your child has asthma, there is one important point to keep in mind. Although asthma is a chronic and serious lung disease, your can lead an active, normal life if you follow the treatments and environmental control measures suggested. You need to partner with us to succeed in effective disease management.

At your initial visit we will take a careful history and perform a physical examination. Allergy testing will usually be performed to investigate possible triggers of the asthma. While still in the office, we will then explain what type of asthma you or your child has. There are four classifications of asthma severity:

  • Mild intermittent
  • Mild persistent
  • Moderate persistent
  • Severe persistent

If you have more than two episodes of asthma symptoms per week persistent asthma is present.  This means that inflammation remains in the airways even without the presence of symptoms. Persistent asthma may become more severe or less severe over time. Our goal will be to first stabilize your symptoms, and then "step down" the level of medication(s) until you are using to the lowest dose possible while continuing in control.

We use this classification in determining which medications to prescribe.

  • For mild intermittent asthma, no daily medication is needed. A short acting bronchodilator ("rescue inhaler") will be prescribed to relieve occasional symptoms and possibly before some exercise.
  • For mild persistent asthma, daily long-term control medication is typically indicated. This will reduce the inflammation in the airways and control the symptoms. A rescue inhaler will also be available.
  • For moderate persistent asthma, you may need an additional medication.
  • For severe persistent asthma, multiple long-term control medications are required, including high-dose inhaled corticosteroids and, if needed, oral corticosteroids.

Tools for the asthma patient

There are three important tools you may leave our office with, in addition to a good understanding of asthma and how you can improve asthma symptoms.

1. Daily Management Plan & Action Plan

We will work with you to develop a daily management plan, describing regular medications and measures to keep your asthma under control.  An action plan, describes steps to take when asthma worsens, including what medications to take and when to contact a physician and/or go to the emergency room or urgent care center.

2. Peak Flow Meter

A peak flow meter for asthma is like a thermometer for a fever. It is an instrument that can look something like a kazoo and measures the airflow when you blow into it quickly and forcefully. Depending on you situation we may recommend the use one at home to guide decisions about when medications need to be increased or decreased, and to determine when to call a physician and/or seek emergency care. This is an inexpensive and helpful device for asthma management. It is not useful in children under five years of age.

3. Environmental Control Plan

An environmental control plan outlines steps you can take to make your home a better living environment if you have allergies. A few steps can go a long way, for example:

  • Encase mattress, box springs and pillows with allergen-impermeable covers.
  • Launder bedding in hot water (temperatures 130 degrees or hotter) regularly.
  • Reduce indoor humidity to less than 50 percent.
  • Minimize use of carpets and upholstered furniture.
  • Remove pets to which you are allergic
  • Eliminate exposure to cigarette smoke.

The ultimate goal of all these measures is to get asthma under control. That means:

  • No coughing, shortness of breath, rapid breathing, wheezing or chest-tightness.
  • No waking up at night because of asthma symptoms.
  • Normal activities, including play, sports and exercise.
  • No episodes of asthma that require a doctor visit, emergency room visit, or urgent care.
  • No absences from school or activities
  • No missed time from work for the parent or caregiver.
  • Normal or near normal pulmonary functions.

In other words, living a happy healthy life with few limitations is the goal.

Date: 1/21/2005

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