Skip to main content

Table 1 Diagnosis of asthma based on medical history, physical examination and objective measurements [4, 6, 7]

From: Asthma

Medical history
• Assess for classic symptoms of asthma:
– Wheezing
– Breathlessness
– Chest tightness
– Cough (with our without sputum)
• Assess for symptom patterns suggestive of asthma:
– Recurrent/episodic
– Occur/worsen at night or early in the morning
– Occur/worsen upon exposure to allergens (e.g., animal dander, pollen, dust mites) or irritants (e.g., exercise, cold air, tobacco smoke, infections)
– Respond to appropriate asthma therapy
• Assess for family or personal history of atopic disease (particularly allergic rhinitis)
Physical Examination
• Examine for wheezing on auscultation
• Examine upper respiratory tract and skin for signs of other atopic conditions
Objective Measurements
• Perform spirometry (preferred) to confirm the diagnosis
– Diagnostic criteria:
■ FEV1 ↑ (after bronchodilator): ≥ 12% and ≥ 200 mL
• Consider PEF as an alternative if spirometry is unavailable
– Diagnostic criteria:
■ PEF ↑ (after bronchodilator): ≥ 20% and 60 L/min
■ Diurnal variation: >20%
• If spirometry (or PEF) is normal, but symptoms are present consider:
– Challenge testing (e.g., methacholine, histamine, mannitol, exercise)
– Non-invasive markers of airway inflammation (exhaled nitric oxide, sputum eosinophilia)
– Trial of appropriate asthma therapy
Allergy testing
• Perform skin tests to assess allergic status and identify possible triggers
  1. FVC: forced vital capacity; FEV 1 : forced expiratory volume in 1 second; PEF: peak expiratory flow