Symptoms, Signs and Diagnosing the Asthma

Symptoms and signs of asthma are variable according to the severity of asthma.

Symptoms: (what patient notice):

The three main symptoms of asthma are tight chest, whistling sound (wheezing) while you breathe, and cough. In some cases, cough at night may be the only symptom. Some may complain chest tightness and wheeze in the morning usually within seconds of waking from sleep (morning dips). It may take many minutes or hours to improve.

Signs: (what doctor finds on examination)

Between asthma attacks, your doctor may not be able to identify any problem while examining the patient. But during an acute attack your rate of breathing will become fast, you'll start using the intercostal muscles (small muscles in between ribs) and the time taken to breathing out the air (expiration time) may be prolonged. In some patients, chest itself appears to be like a barrel shape (hyperinflation). Using a stethoscope, your doctor would be able to hear high pitching whistling sounds all over the lung area. Using a peak flow meter (a hand held device which is helpful in assessing the amount of air that the patient can breathe out), he may notice a decreased peak flow rate.

Feature of severe asthma attack:

In severe attack, patient may be very breathless and would not be able to speak. Sometimes they may not be able to form phrases or sentences. Heart beats fast and pulse rate may go above 110/minute. In very severe attack, heart rate becomes very slow (bradycardia), lips may become blue and patient may become drowsy. On checking with stethoscope, chest may be silent, as no air is entering the lungs. Those patients would need immediate attention and possible assisted breathing. In a year, around 2-3 people for every 100,000 population die due to severe asthma attack, which could be avoidable if these patients seek timely medical help.

Diagnosis:

Your Doctor would be normally able to diagnose asthma after asking you some questions and then examining you.

Probability of asthma is very high if any patient has the following:

Symptoms such as chest tightness, wheezing sounds on breathing and difficulty in breathing particularly if the symptoms are worse in the early morning, or exposure to allergens or cold air or after taking tablets like aspirin, or brufen.

If the patient suffers from any type of allergic problems like hay fever or eczema.

If any of patient's family members suffer from asthma or hay fever or eczema.

Low peak flow rate (the amount of air that the patient can breathe out which can be measured by a device called peak flow meter.)

If the doctor is certain about the diagnosis he/she will prescribe medications directly even without any investigations. In some cases it would be difficult to come to a conclusion and in those patients, doctor would organise some tests before making a diagnosis.

This third part of "Walking with a Doc Series - Asthma", describes signs and symptoms of asthma and factors that would be helpful to diagnose asthma.