There is no definitive test for asthma.
Diagnosis is by clinical assessment.
• Nocturnal, exercise and / orallergy induced.
• Wheeze heard on auscultation. If asthma thought likely, then use trial of treatment (e.g. six weeks ICS) to confirm.
• More than one of: episodic breathlessness; wheeze; cough; chest tightness.
• Spirometry or peak flow measurements can aid diagnosis, but may need repeated for variation. Normal results do not exclude asthma.
• If diagnosis uncertain, then refer (see Box F).
Asthma Guidelines, Primary Care (33)
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People with asthma under-report symptoms.
Use a validated questionnaire, e.g.: RCP 3 Questions
• Have you had difficulty sleeping because of your asthma symptoms - including cough?
• Have you had your usual asthma symptoms during the day - cough, wheeze, chest tightness or breathlessness?
• Has your asthma interfered with your usual activities - housework, work, school etc?
Under-use of preventive therapy is common - review prescriptions ordered, address patient concerns regarding steroids.
Check Inhaler technique to make sure patient can use their inhaler / change as required. Use Personal Asthma Action Plan as a tool.
Click for NHSGGC Asthma self-management plan
• Grade A evidence; offer to all, but particularly those who are poorly controlled.
• Written and personalised, focusing on patient’s needs and preferences. Brief, simple education linked to patient goals likely to be most effective - “If we could make one thing better with your asthma, what would it be?”
• May be based on symptom or PEFR - latter not essential. A process not an event.
Preferred choices highlighted, refer to NHSGGC Inhaler Device Guide.
• Assess control of symptoms using agreed tool – RCP 3 questions.
• Review therapy including inhaler technique.
• Frequency of exacerbations / oral steroids / A&E, OOH contacts and acute admissions.
• Peak flow (percentage of best).
• Personal Asthma Action Plan – See Box B above
• Smoking cessation
• Consider steroid side effects in patients on high dose inhaled steroid (see C above). Consider DEXA referral for osteoporosis if on high dose inhaled steroid for 10 years or oral steroid for >3 months in the last year, and 10 year risk of major fracture >10%.
Use Qfracture risk calculator or FRAX.
• Rhinitis - control may improve asthma control.
• GORD - worth treating if present.
• Infection - confirm with sputum culture if recurrent infection suspected - most asthma exacerbations do NOT require antibiotics.
• Obesity - may contribute to poor control.
• Smoking - associated with usual issues plus reduced effect of inhaled steroid.
• Dysfunctional breathing.
• Diagnostic uncertainty:
- Symptoms without variation in PEFR or spirometry.
- Poor response to treatment, following adequate trial of treatment.
- Possible causative agent, especially occupational.
• Poor control
- Frequent exacerbations.
- Persisting symptoms / frequent exacerbations despite additional add-on therapies.
See NHSGGC Patient Information Leaflets
MDI / Breath actuated MDI:
Preparation (shake inhaler, breathe out)
Co-ordinate activation (unless breath activated MDI)
Slow, steady inhalation
Breath-hold for 10 seconds
Wait 30 seconds before repeating.
Spacer: Breathe in immediately after activation
Single puff of inhaler
Breathe in slowly
Either breath-hold for 10 seconds or tidal breathe in and out of mouthpiece 5 times
Wait 30 seconds before repeating, even if multi-dosing.
Dry Powder: Fast, deep inhalation.