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Diagnostic Tests for Asthma
Diagnostic tests for Asthma:
A diagnosis of asthma is made only after a complete evaluation, history, and physical is done by a health care professional. This will help to determine the type and severity of asthma you have and the most appropriate and effective treatment plan for you. Diagnostic testing can include lung function tests, such as a spirometry, which measures how much air you are able to move in and out of your lungs. This easy, painless, and noninvasive breathing test is often done regularly to monitor how well treatments are working. A chest X-ray may be done, which can evaluate a number of factors, including the presence of other conditions that may occur with or without asthma symptoms, such as pneumonia, and bronchitis. A bronchoprovocation test may also be performed to measure lung function after a variety of factors that potentially provoke asthma symptoms are introduced to the patient. Allergy testing is also commonly performed to determine a person's individual sensitivities to allergens, substances that trigger an allergic reaction that can result in asthma symptoms.
Home Diagnostic Testing
These home medical tests may be relevant to Asthma:
- Allergies -- Related Home Tests
- Lung & Respiratory Health Tests:
- Food Allergies & Intolerances: Home Testing:
Tests and diagnosis discussion for Asthma:
NHLBI - Your Asthma Can Be Controlled: NHLBI (Excerpt)
Peak flow meters can help you find out what your triggers are. Peak flow meters measure how well you are breathing. The peak flow meter is simple and small. It can be used at home or at work. Talk to your doctor about this. (Source: excerpt from NHLBI - Your Asthma Can Be Controlled: NHLBI)
NHLBI, Asthma Age Page: NHLBI (Excerpt)
Several tests may be needed to tell what is causing your symptoms. These tests include spirometry (to measure how open your airways are), a chest x-ray, an electrocardiogram (to show whether you have heart disease), and a blood test. Accurate diagnosis is important because asthma is treated differently from other diseases with similar symptoms. (Source: excerpt from NHLBI, Asthma Age Page: NHLBI)
Diagnosis of Asthma: medical news summaries:
The following medical news items are relevant to diagnosis of Asthma:
- A special CT scan to image asthma effects
- Asthma diagnosing technique picks up misdiagnoses
- Asthma diagnosis by using Aridol awaiting approval in Australia
- Asthma prescription to include exercise
- Best practice for asthma medication
- Childhood asthma is a chronic problem
- Coughing issues
- Dust mite allergy
- Eczema asthma link
- Eczema may be a sign of other allergic conditions
- Increasing incidence of chronic disease, not just for the elderly
- Oral allergy syndrome
- Sinusitis factor in prolonged cough
- Smoking addiction
- Suspicion of asthma
- Teen allergy results in disability
- More news »
Diagnostic Tests for Asthma: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the diagnostic tests for Asthma.
STRIDOR:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine tests may include a CBC; sedimentation rate; smear and culture of material from the nose, throat, and sputum; x-ray of the chest and sinuses; and, in adults, an EKG. In adults also it might be wise to order a chemistry panel, thyroid profile, and VDRL test, depending on the clinical picture. Direct laryngoscopy can now be done in the office with the fiberoptic laryngoscope. In addition, fiberoptic bronchoscopy may be valuable. A Tensilon test may need to be done. An ear, nose, and throat specialist should be consulted before ordering expensive diagnostic tests. If there are neurologic signs, a neurologist should be consulted.
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
WHEEZING:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The CBC, sedimentation rate, chest x-ray, EKG, sputum analysis and culture, and pulmonary function testing will usually assist with the clinical diagnosis. Bronchoscopy may be needed also, especially when there is hemoptysis .
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Stridor:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
When the patient’s condition permits, obtain a patient history from him or a family member. First, find out when the stridor began. Has he had it before? Does he have an upper respiratory tract infection? If so, how long has he had it?
Ask about a history of allergies, tumors, and respiratory and vascular disorders. Note recent exposure to smoke or noxious fumes or gases. Next, explore associated signs and symptoms. Does stridor occur with pain or a cough?
Then examine the patient’s mouth for excessive secretions, foreign matter, inflammation, and swelling. Assess his neck for swelling, masses, subcutaneous crepitation, and scars. Observe the patient’s chest for delayed, decreased, or asymmetrical chest expansion. Auscultate for wheezes, rhonchi, crackles, rubs, and other abnormal breath sounds. Percuss for dullness, tympany, or flatness. Finally, note burns or signs of trauma, such as ecchymoses and lacerations.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Wheezing [Sibilant rhonchi]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient isn’t in respiratory distress, obtain a history. What provokes his wheezing? Does he have asthma or allergies? Does he smoke or have a history of a pulmonary, cardiac, or circulatory disorder? Does he have cancer? Ask about recent surgery, illness, or trauma or changes in appetite, weight, exercise tolerance, or sleep patterns. Obtain a drug history. Ask about exposure to toxic fumes or any respiratory irritants. If he has a cough, ask how it sounds, when it starts, and how often it occurs. Does he have paroxysms of coughing? Is his cough dry, sputum producing, or bloody?
Ask the patient about chest pain. If he reports pain, determine its quality, onset, duration, intensity, and radiation. Does it increase with breathing, coughing, or certain positions?
Examine the patient’s nose and mouth for congestion, drainage, or signs of infection, such as halitosis. If he produces sputum, obtain a sample for examination. Check for cyanosis, pallor, clamminess, masses, tenderness, swelling, distended jugular veins, and enlarged lymph nodes. Inspect his chest for abnormal configuration and asymmetrical motion, and determine if the trachea is midline. (See Detecting slight tracheal deviation, page 599.) Percuss for dullness or hyperresonance, and auscultate for crackles, rhonchi, or pleural friction rubs. Note absent or hypoactive breath sounds, abnormal heart sounds, gallops, or murmurs. Also note arrhythmias, bradycardia, or tachycardia. (See Evaluating breath sounds.)
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Stridor:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
When the patient’s condition permits, obtain a patient history from him or a family member. First, find out when the stridor began. Has he had it before? Does he have an upper respiratory tract infection? If so, how long has he had it?
Ask about a history of allergies, tumors, and respiratory and vascular disorders. Note recent exposure to smoke or noxious fumes or gases. Next, explore associated signs and symptoms. Does stridor occur with pain or a cough?
Then examine the patient’s mouth for excessive secretions, foreign matter, inflammation, and swelling. Assess his neck for swelling, masses, subcutaneous crepitation, and scars. Observe the patient’s chest for delayed, decreased, or asymmetrical chest expansion. Auscultate for wheezes, rhonchi, crackles, rubs, and other abnormal breath sounds. Percuss for dullness, tympany, or flatness. Finally, note any burns or signs of trauma, such as ecchymoses and lacerations.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Wheezing [Sibilant rhonchi]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient isn’t in respiratory distress, obtain a history. What provokes his wheezing? Does he have asthma or allergies? Does he smoke or have a history of a pulmonary, cardiac, or circulatory disorder? Does he have cancer? Ask about recent surgery, illness, or trauma and recent changes in appetite, weight, exercise tolerance, or sleep patterns. Obtain a drug history. Ask about exposure to toxic fumes or any respiratory irritants. If he has a cough, ask how it sounds, when it starts, and how often it occurs. Does he have paroxysms of coughing? Is his cough dry, sputum producing, or bloody?
Ask the patient about chest pain. If he reports pain, determine its quality, onset, duration, intensity, and radiation. Does it increase with breathing, coughing, or certain positions?
Examine the patient’s nose and mouth for congestion, drainage, or signs of infection such as halitosis. If he produces sputum, obtain a specimen for examination. Check for cyanosis, pallor, clamminess, masses, tenderness, swelling, distended jugular veins, and enlarged lymph nodes. Inspect his chest for abnormal configuration and asymmetrical motion, and determine if the trachea is midline. (See Detecting slight tracheal deviation, page 766.) Percuss for dullness or hyperresonance, and auscultate for crackles, rhonchi, or pleural friction rub. Note absent or hypoactive breath sounds, abnormal heart sounds, gallops, or murmurs. Also note arrhythmias, bradycardia, or tachycardia. (See Evaluating breath sounds. See also Differential diagnosis: Wheezing, pages 826 and 827.)
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Stridor:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Focused physical examination (PE)
1. The PE should include vital signs, notably temperature and respiratory rate, and pulse, with emphasis on general appearance and examination of the head and neck, including ears, nose, and throat.
2. Signs of respiratory distress may be present, including dyspnea, tachypnea, chest retractions, nasal flaring, and stridor. If cyanosis is present, this is an ominous sign (2,4) (Chapter 8.2).
B. Additional physical examination may reveal:
1. A toxic-appearing child with high fever, drooling, severe respiratory distress, and preference for a sitting and forward-leaning position (1,4)
2. Varying degrees of anxiety, which will increase during examination, cause a worsening of stridor (1,4)
Testing
A. The best test is a lateral neck x-ray study to assist with a diagnosis that is mostly made on clinical grounds. Films of the larynx and trachea in anteroposterior and lateral neck views may show narrowing of the trachea or extrinsic pressure on the tracheobronchial airway. Acutely, lateral neck radiographs showing the classic swollen glottis described by some as a thumbprint, assist with the diagnosis of acute supraglottitis and eminent respiratory collapse. Chest x-ray studies are of little value. Films showing hyperinflation or bronchial thickening may help to make a diagnosis of asthma rather than stridor. Additionally, foreign body aspiration or mass will be elucidated in x-ray studies (2).
B. Tomograms or computed tomography (CT) of the neck may provide additional information, especially in chronic stridor (2).
C. Blood tests (e.g., complete blood count) can be useful in the acutely ill patient, especially if viral or bacterial infection is suspected.
D. With suspicion that the stridor is a result of a laryngomalacia or laryngeal lesions such as papilloma, direct laryngoscopy is the test of choice for accurate diagnosis. Direct observation via fiberoptic bronchoscope positioned in the pharynx would provide diagnostic views of the larynx (2,4).
Diagnostic assessment
In making the diagnosis of stridor, two key elements exist: acute onset in a toxic-appearing patient, versus chronic stridor in a relatively stable patient.
A. Acute stridor
1. The most likely cause of acute stridor in the febrile child with the additional features of barking cough and antecedent coryza is laryngotracheobronchitis or croup. Acute stridor is a non–life-threatening condition accounting for 90% of stridor cases. Classically, it improves with exposure to moist air. It has a viral cause, usually from one of the following: respiratory syncytial virus, rhinovirus, adenovirus, parainfluenza virus, and influenza virus. Generally, this diagnosis is made on clinical grounds (1). The child is less ill and, although often febrile, not toxic appearing. The entire illness usually abates in 5 days. Hospitalization, unlike with epiglottitis, is rarely needed (2).
2. In the toxic patient with fever, respiratory distress, sore throat, or drooling, especially in the younger age group, consider epiglottitis—a medical emergency. As use of the Haemophilus influenzae vaccine has increased in recent years, acute epiglottis is becoming increasingly rare. H. influenzae is the most common bacterial cause of stridor, although streptococcus, staphylococcus and viral agents are also possible causes.
3. The patient with a history of suspected foreign body aspiration will have similar symptoms without fever. Foreign body aspiration is common in the 1- to 2-year age groups, although it does occur in adults. It can be a cause of chronic stridor (3).
4. Additionally, an acute allergic reaction can cause stridor. The history should herald a possible offending agent and, although respiratory collapse may be eminent, the patient will not be toxic, as no infectious agent is involved.
5. Trauma can also cause laryngeal damage; however, the history will assist with this diagnosis.
B. Chronic stridor. For the most part, these causes of stridor occur in early childhood. With the exception of laryngeal papillomas, tumors, and subglottic stenosis after instrumentation as in intubation (there is a congenital form also), foreign body aspiration with partial obstruction and hysterical stridor can occur at any age. Laryngomalacia and laryngeal lesions are caused by webs, hemangiomas, and cysts; they are usually identified early in life (1–3).
References
1. Pryor MP. Noisy breathing in children. Postgrad Med 1997;101:103–112.
2. Behrman RE, Kliegman RM, Arvin AM. Nelson textbook of pediatrics. Philadelphia: WB Saunders, 1996:241, 1173, 1198, 1238.
3. Behrman RE, Vaughan VC. Nelson textbook of pediatrics. Philadelphia: WB Saunders, 1983:1031–1032, 1076–1077.
4. Tintinalli JE, Ruiz E, Krome RL. Emergency medicine: a comprehensive study guide. New York: McGraw-Hill, 1996:247–251.
5. Campbell AGM, MacIntosh N. Textbook of pediatrics. London: Pearson Ltd., 1998:
508–513, 563.
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Wheezing:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Vital signs. A full set of vital signs is essential to the assessment of the wheezing patient. The respiratory rate and the pulse are a more objective, and often more accurate, assessment of the severity of wheezing than the auditory volume of the wheezing itself. Fever suggests a concurrent respiratory infection. Hypotension is an ominous sign that points to a decompensating patient.
B. Lung examination. During auscultation, note the location, intensity, and duration of wheezing. Wheezing caused by asthma, chronic obstructive pulmonary disease (COPD), or interstitial disease should be diffuse and symmetric and present during expiration. The expiratory phase will be prolonged. Focal obstruction (e.g., tumors and foreign bodies) can give asymmetric findings and inspiratory wheezing. Mucus plugging will change with cough. Rhonchi and crackles suggest a concurrent infectious process. Percussion and egophony can be present with consolidation.
Testing
A. Pulmonary function. A peak flow meter is a valuable initial assessment of airway obstruction and can be done quickly and cheaply in the office. It is also an excellent measure of progression of disease or success of treatment. Pulse oximeter is another quick, noninvasive office technique to assess the severity of both chronic disease and acute respiratory distress. Full spirometry, although not available in all primary care offices, gives additional diagnostic information that can differentiate among asthma, COPD, and fixed airway obstruction.
B. Chest x-ray study. Plain chest films will identify consolidation, masses, mediastinal shifts, and hyperaeration.
C. Clinical laboratory tests. A complete blood count may demonstrate signs of an acute bacterial infection. Polycythemia is a sign of chronic hypoxia (Chapter 16.5). Eosinophilia can indicate asthma or allergic disease (Chapter 16.2). Angiotensin-converting enzyme levels are elevated in sarcoidosis. A tuberculin skin test should be considered in all patients with wheezing or chronic cough.
Diagnostic assessment
The history and physical examination are the key elements to an acute diagnosis. A consistent exposure or reaction history, coupled with an elevated serum IgE or eosinophilia, indicates allergic disease. Wheezing in the setting of acute bronchitis or sinusitis is not true asthma and the patient can be reassured that this is not the beginning of a chronic disease. Inspiratory wheezing, or stridor, indicates upper airway obstruction or psychogenic wheezing. A normal, or nearly normal, peak flow is reassurance that good air exchange is occurring, regardless of the loudness of the wheezing. The pulse oximetry will differentiate between severe obstruction and poor cooperation with the peak flow testing. When confusion still exists, spirometry will clarify the diagnosis in most cases. The diagnosis and treatment of most cases of wheezing is within the scope of practice of the primary care physician.
References
1. Pryor MP. Noisy breathing in children. Postgrad Med 1997;101:103–111.
2. Martinati LC, Boner AL. Clinical diagnosis of wheezing in early childhood. Allergy 1995;50:701–710.
3. Meslier N, Charbonneau G, Racineux JL. Wheezes. Eur Respir J 1995;8:1942–1948.
4. Goldman J. All that wheezes is not asthma. Practitioner 1997;241:35–38.
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Wheezing:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
A wheeze is a continuous musical sound produced by vibration of airway walls when they are near closure. A wheeze consisting of a single musical note indicates small airways disease, usually asthma. Polyphonic wheezes (multiple musical notes) are produced by dynamic compression of large central airways.
Stridor signifies central airway obstruction, and is an ominous portent of impending complete airway closure. Causes such as an aspirated foreign body or bronchogenic cancer should be suspected when the onset of wheezing is sudden and focal, allergic markers and specific triggers are absent, and response to bronchodilator is poor. A history of aspiration, or smoking and clubbing are also helpful.
Nocturnal wheezing could be the result of congestive heart failure (paroxysmal nocturnal dyspnea) or gastric aspiration with reflux.
Dyspnea on exertion correlates with an FEV1 below 50% predicted, and dyspnea at rest with FEV1 below 25% predicted. Forced expiratory time (FET) is measured by ausculting over the trachea, and timing until airflow is no longer heard. FET of 9 seconds predicts an FEV1/FVC ratio of 70%. Stridor indicates that the airway diameter is less than 5 mm.
Source: Field Guide to Bedside Diagnosis, 2007
Stridor:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Examine the patient’s mouth for excessive secretions, foreign matter, inflammation, and swelling. Assess his neck for swelling, masses, subcutaneous crepitation, and scars. Observe the patient’s chest for delayed, decreased, or asymmetrical chest expansion. Auscultate for wheezes, rhonchi, crackles, rubs, and other abnormal breath sounds. Percuss for dullness, tympany, or flatness. Finally, note any burns or signs of trauma, such as ecchymoses and lacerations.
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Wheezing:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Examine the patient’s nose and mouth for congestion, drainage, or signs of infection, such as halitosis. If he produces sputum, obtain a sample for examination. Check for cyanosis, pallor, clamminess, masses, tenderness, swelling, distended jugular veins, and enlarged lymph nodes. Inspect his chest for abnormal configuration and asymmetrical motion, and determine if the trachea is midline. (See Detecting slight tracheal deviation, page 655.) Percuss for dullness or hyperresonance, and auscultate for crackles, rhonchi, or pleural friction rubs. Note absent or hypoactive breath sounds, abnormal heart sounds, gallops, or murmurs. Also note arrhythmias, bradycardia, or tachycardia. (See Evaluating breath sounds, pages 720 and 721.)
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Wheezing:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Stertor, Stridor, and Airway Obstruction:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Stridor:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
When the patient's condition permits, obtain a patient history from him or a family member. First, find out when the stridor began. Has he had it before? Does he have an upper respiratory tract infection? If so, how long has he had it?
Ask about a history of allergies, tumors, and respiratory and vascular disorders. Note recent exposure to smoke or noxious fumes or gases. Next, explore associated signs and symptoms. Does stridor occur with pain or cough?
Then examine the patient's mouth for excessive secretions, foreign matter, inflammation, andswelling. Assess his neck for swelling, masses, subcutaneous crepitation, and scars. Observe the patient's chest for delayed, decreased, or asymmetrical chest expansion. Auscultate for wheezes, rhonchi, crackles, rubs, and other abnormal breath sounds. Percuss for dullness, tympany, or flatness. Finally, note burns or signs of trauma, such as ecchymoses and lacerations.
Source: Nursing: Interpreting Signs and Symptoms, 2007
Wheezing [Sibilant rhonchi]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient isn't in respiratory distress, obtain a history. What provokes his wheezing? Does he have asthma or allergies? Does he smoke or have a history of a pulmonary, cardiac, or circulatory disorder? Does he have cancer? Ask about recent surgery, illness, or trauma or changes in appetite, weight, exercise tolerance, or sleep patterns. Obtain a drug history. Ask about exposure to toxic fumes or respiratory irritants. If he has a cough, ask how it sounds, when it starts, and how often it occurs. Does he have paroxysms of coughing? Is his cough dry, sputum producing, or bloody?
Ask the patient about chest pain. If he reports pain, determine its quality, onset, duration, intensity, and radiation. Does it increase with breathing, coughing, or certain positions?
Examine the patient's nose and mouth for congestion, drainage, or signs of infection, such as halitosis. If he produces sputum, obtain a sample for examination. Check for cyanosis, pallor, clamminess, masses, tenderness, swelling, distended jugular veins, and enlarged lymph nodes. Inspect the patient's chest for abnormal configuration and asymmetrical motion, and determine if the trachea is midline. (See Detecting slight tracheal deviation, page 597.) Percuss for dullness or hyperresonance, and auscultate for crackles, rhonchi, or pleural friction rubs. Note absent or hypoactive breath sounds, abnormal heart sounds, gallops, or murmurs. Also note arrhythmias, bradycardia, or tachycardia. (See Evaluating breath sounds,
Source: Nursing: Interpreting Signs and Symptoms, 2007
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