Asthma Medicines

The Medical History

All diagnosis begins with a thorough medical history. The physician looks for the age at onset of symptoms and associated allergies. Evidence of air-way obstruction may be suggested by a report of wheezing and shortness of breath. Coughing may be a prominent symptom and the physician will inquire as to the character of phlegm produced. The physician will also ask about the presence of nasal symptoms or sinus pain or infection as well as the presence of allergic skin problems such as rash ( eczema) or hives (urticaria). A diminished sense of smell or taste may suggest the presence of nasal polyps. Common questions include: “What seems to trigger your attack?” “What are your attacks like?” Asthma often worsens at night and the patient may be asked,”Do you ever awaken with an attack?” The timing of attacks other than at night is also important. A relationship between asthma and hormonal influences should be explored. Many women note increased asthmatic symptoms before their period, as well as changes during pregnancy. The physician will ask about the effect of exercise on the patient’s symptoms since asthma may occasionally occur only with exercise. Emotional factors will also be investigated as potential triggers: “Are you under more stress?” A thorough family history will also be obtained since the presence of asthma or allergy in closely related family members will support the diagnosis. The physician will also ask about occupation and possible exposures to irritating chemicals, dust, or fumes. To help establish the hyperresponsiveness evident in asthma the physician will ask how the patient reacts to changes in temperature, humidity, air pollution, or the presence of cigarette smoke, fumes, or odors. Reaction to foods containing sulfites as well as to drugs (especially aspirin and penicillin) are also important historical factors.

Looking For Asthma Triggers

When obtaining the initial history the physician must be like a detective, especially in examining sources of irritation that may have precipitated or irritated an underlying asthmatic condition. Both the home and workplace must be reviewed in that context. Many patients are aware of the “sick building syndrome” in which asthma may be produced by a particular contaminant, and thus are able to give important information. The type of heating and cooling system in place should be known. Although the patient may be a nonsmoker, sources of secondhand smoke should be investigated. “Have you recently moved or renovated?”Do you have pets?”How often do you clean your humidifier?” If attacks occur frequently at night the bedroom should be singled out for review. “Do you have a mattress cover?” “What type of floor covering do you have?”

It is not unusual for a patient to supply information that may identify a specific source of irritation and asthma attacks. A thirty-four-year-old man was referred to me for asthma that was extremely difficult to control. He had had many severe attacks and was receiving several asthma medications. Corticosteroids had been prescribed several times and he had noted side effects of weight gain and stomach upset. The patient noted that he was often well during the day but worsened at night, especially after returning to his apartment. The patient often worked in his bedroom where he spent a great deal of time when he was home. He was often awakened during the night by wheezing and shortness of breath and noted that he was “worse in the morning.” Asthma attacks often occurred whenever he attempted to clean his apartment. I suspected he was allergic to dust mites and that was confirmed by allergy testing. The patient acquired a mattress cover and began following several recommendations. He returned for a visit after six weeks and noted he was now sleeping through the night and awakening without wheezing. His medications were sharply reduced and he has not required further corticosteroids. I often remind him that the credit for his improvement belongs to his mattress cover.

Participating in Your Care

Patients can be extremely helpful by detailing that type of specific information for the physician. Write down the important facts in your history that you want to present to your physician. If this narrative is lengthy, send the material ahead of you with other medical records so our physician can review it in detail before your visit. You can be anctive participant in your care. Start at the initial interview with your physician. The more detailed information you can supply, particularly in the areas noted above, the more accurate the diagnosis will be. It is also helpful to describe to your physician how your symptoms have affected your life at home and at work. It is extremely helpful for your physician to know what kind of support you as a patient can rely on as well as whether there are any adverse influences in your life, either environmental or emotional. Reviewing this material is time consuming and addressing the relief of asthma may take precedent, so tell your physician you want to discuss certain topics at another time. Use a portion of each office visit to discuss a specific topic.

Tho often patients are treated only when severe asthmatic symptoms emerge, often requiring emergency room care. While this is essential and often life saving the “quick fix” of ER treatment is not designed for the careful historical review needed to make the correct diagnosis of asthma.

The Physical Examination

The next step in the diagnosis of asthma is the physical examination, where your physician seeks to correlate the historical information you have provided. For example, the skin and nasal passages are examined for allergic manifestations such as eczema and rhinitis. In the nose, the finding of nasal polyps identifies the patient as someone who may have severe asthma or allergy.

Examination of the chest is extremely important. The physician will note the quality of the breath sounds as air is inhaled and exhaled. When there is airway obstruction the flow of air through the bronchial tubes is turbulent and often creates wheezing, which is more commonly noted upon exhaling. In addition, the narrowed passages prolong the time it takes for air to be exhaled and the physician will note a prolonged expiratory phase. Although the patient’s breathing may be quiet at rest, when asked to take a deep breath and exhale, wheezing and cough may then occur. This maneuver enables a physician to discover an airway obstruction.

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