Diagnosis of Asthma in Adults and Adolescents
Signs and Symptoms
- Cough
- Wheezing
- Chest tightness
- Shortness of breath
History
- Family history of asthma or other atopic conditions?
- Any recurrent attacks of wheezing?
- Does the patient have a troublesome cough at night?
- Does the patient wheeze or cough after exercise?
- Does the patient experience symptoms after exposure to any of the triggers?
- Is there worsening of symptoms after taking the causative medications?
- Does the patient’s cold “go to the chest” or take more than 10 days to clear up?
- Are symptoms improved by appropriate asthma treatment?
- Are there any features suggestive of occupational asthma?
Physical Examination
- May be normal in stable and controlled asthma
- Bilateral expiratory wheezing
- Examination of the upper airways
- Other allergic manifestations: e.g., atopic dermatitis/eczema
- Consider alternative diagnosis when there is localized wheeze, crackles, stridor, clubbing or heart murmurs.
Classification of Asthma Severity
Clinical Features Before Treatment
| Symptoms | Nocturnal Symptoms | FEV₁ or PEF |
|---|---|---|
| STEP 4 Severe Persistent | Frequent | < 60% predicted Variability > 30% |
| STEP 3 Moderate Persistent | > 1 time a week | 60 to 80% predicted Variability > 30% |
| STEP 2 Mild Persistent | > 2 times a month | > 80% predicted Variability 20 to 30% |
| STEP 1 Intermittent | < 2 times a month | > 80% predicted Variability < 20% |