I have been writing this column for about nine years and have discussed asthma, or some aspect of asthma, more than once. I wonder if I am making an impact. I continue to see patients who were told they have asthma, or are taking medications for asthma, but cannot relate how their diagnosis was made and how they are being followed. Many times I am told that “someone told me I have asthma” and I have been on treatment ever since.
To be clear, the workup for asthma has several elements which need to be addressed so that the diagnosis and, therefore, the treatment, is accurate. To begin, the patient must have symptoms compatible with asthma and then undergo appropriate testing, including a challenge test, to see if their airways do go into spasm. Alternate diagnoses need to be considered, along with an assessment for asthma-associated diseases. Environmental exposures, which can trigger bronchospasm, need to be identified and avoided, and an evaluation of the current or new medication program the patient is using should be reviewed, including an observation of inhaler technique to be sure the patient is getting the medication properly and effectively. Lastly, checking certain so-called “biomarkers” for the patient to determine something called a phenotype is the newest part of a complete evaluation. This may help determine the need for new and specialized medications.
Do not accept the diagnosis of asthma without having these points addressed. Your treatment success depends on it.