Asthma
Asthma is a chronic lung disease that causes persistent airway inflammation that worsens when triggered by allergens or irritants, making it hard to breathe and causing other symptoms.
How your provider diagnoses asthma
To begin, your UCHealth primary care provider will take your complete health history and give you a physical exam to rule out obstructive pulmonary disease (COPD) and other conditions.
Then your provider or an allergist may perform lung function tests, including:
- Peak flow. A peak flow meter measures how hard you can breathe out.
- Spirometry. A spirometer measures the amount and speed of air you can breathe out. Often the test is performed twice, once before and then once after treatment with albuterol, a medication used to treat asthma.
Getting a precise diagnosis.
Based on initial test results, you may need additional tests for a proper diagnosis, including:
- Allergy testing. Used to identify allergies to pets, dust, mold and pollen, which can lead to allergen immunotherapy (allergy shots).
- Imaging tests. A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and sinuses can identify any structural abnormalities or diseases.
- Methacholine challenge. Methacholine is a known asthma trigger that will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma.
- Nitric oxide test. Measures the amount of nitric oxide in your breath.
- Sputum eosinophils test. Looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you cough out.
- Provocative testing for exercise and cold-induced asthma. Measures your airway obstruction before and after vigorous physical activity or several breaths of cold air.
Your primary care provider will refer you to a UCHealth respiratory specialist as needed.
Types of asthma
Asthma types determine best treatments.
Based on your diagnosis and symptoms, your provider will classify your asthma to help determine the best treatment for your condition and lifestyle.
Asthma is classified into 4 general categories:
- Mild intermittent. Mild symptoms up to 2 days a week and up to 2 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 1 night a week.
- Severe persistent. Symptoms throughout the day on most days and frequently at night.
Adjusting asthma treatments.
Asthma severity often changes over time, so your provider will adjust your treatment plan as needed.
In addition to the 4 general classifications, some people with asthma fall into other categories that we consider when developing treatment options:
- Allergic asthma. Allergies and asthma are connected for some people. An allergen like dust mites can also cause an asthma flare.
- Childhood asthma. The majority of children who develop asthma do so before the age of 5. Fortunately, childhood asthma can go away in adulthood.
- Exercise-induced bronchoconstriction (EIB) or exercise-induced asthma (EIA). Asthma symptoms present only during physical activity, in people with asthma and in people who are otherwise healthy.
- Occupational asthma. Caused by inhaling fumes, gases, dust or other potentially harmful substances typically found at a work site.
Customized treatment plans
Your primary care provider and/or allergist will develop a customized treatment plan based on your symptoms, age, general health and severity of your asthma.
Your asthma treatment plan will emphasize avoidance—learn your asthma triggers and how to avoid them—and it will prescribe the right medication for you:
Long-term asthma control medications.
You must take these medicines daily. They include:
- Anti-inflammatory medicines. Oral corticosteroids can reduce or prevent airway swelling.
- Bronchodilators. Relax muscles around the airways.
- Leukotriene modifiers. Block the action of certain chemicals called leukotrienes, which cause airway inflammation and narrowing
- Anti-IgE (omalizumab). An injection given once or twice monthly to reduce allergic reactions.
- Anti-IL-5 (Interleukin-5) agents. An injection that blocks a chemical in the body called IL-5.
Fast-relief medicines.
These fast-relief medicines quickly relax the muscles around the airways:
- Inhaled short-acting beta2-agonists.
- Inhaled anticholinergics. Block a certain chemical called acetylcholine that contracts the muscles and causes more mucus in the airways.
- Inhaled corticosteroids. Delivered through an inhalation device, such as metered-dose inhaler (MDI), nebulizer or dry powder/rotary inhaler. Inhaled medicines go right to the lungs and have fewer side effects than oral medicines.
References
Center for Disease Control and Prevention (CDC). Asthma (https://www.cdc.gov/asthma/default.htm)
National Heart, Lung, and Blood Institute (NHLBI). Asthma – What Is Asthma? (https://www.nhlbi.nih.gov/health/asthma)
Asthma and Allergy Foundation of America. Asthma Information for Patients (https://www.aafa.org/asthma.aspx)