It may take some people a long time to recognise a pattern of symptoms they have been experiencing over time. Some people didn’t notice or pay attention to their own symptoms but friends or family may have recognised the possibility and suggested visiting the GP.
A GP explains what happens when someone attends the surgery with symptoms of asthma
In our interviews people talked about what had led to their asthma diagnosis. They had been diagnosed at different times, childhood, adolescence and later in life. The paths to diagnosis were many and varied, and not always clear-cut. It might take a series of events and possibly several visits to the GP before a firm diagnosis of asthma could be given. Typically people who went to see the GP with symptoms recalled the GP taking a history, asking if there were any instances of asthma within the family, listening to the chest, using a peak flow meter to test lung function. Sometimes they remembered being referred for other tests.
Val asked her GP to check her breathing. A Spirometry test showed her breathing was quite bad. Trying a preventive inhaler helped to reach a diagnosis
The two most common tests that are used to help check lung function are peak flow test and spirometry.
Peak flow test
A small hand-held device called a peak flow meter is used to measure how fast you can blow air out of your lungs in one breath which indicates how much the airways are narrowed. Patients may be given a peak flow meter to take home and asked to keep a diary of measurements and symptoms. To make a diagnosis of asthma, the peak flow reading must vary over time or improve after treatment with an inhaler. The peak flow meter can also help people at home to monitor their condition themselves. (See Managing asthma, reviews and action plans).
When Alastair’s asthma was diagnosed he was given medication and asked to record his peak flow measurement for a period of time.
This test helps to assess how well the lungs are functioning. The spirometer measures the volume of air breathed out in one second, and the total amount of air breathed out. The readings are compared with normal measurements for your age, which can show if your airways are obstructed.
Val was referred to have a spirometry test when she visited the surgery with breathing problems.
The diagnosis of asthma is broadly based on a characteristic pattern of symptoms and signs and the absence of an alternative explanation. Most common are frequent and recurrent wheeze, cough, difficulty in breathing or chest tightness. They may often be worse at night and in the early morning, and they may be triggered by exercise or exposure to cold or damp air or allergens such as pollen or animal fur.
Asthma is more likely if there is a family history (British Thoracic Society (BTS) Guidelines). Where there is a family history of asthma the symptoms may be recognised more quickly within the family.
The GP tested Melissa’s breathing after she fainted in PE. She was surprised to hear she had asthma, though her mum’s boyfriend had been suspecting it.
Ann eventually suggested to her GP that as she had a family history of asthma, it might be worth trying asthma medication
In some cases a confident diagnosis could be made at once, but as Val explains, testing if someone responds to treatment is often part of the diagnostic process. If an inhaler relieves or prevents symptoms, the diagnosis can usually be confirmed but it may still take a while to find the best dose and type of medication for the individual.
Julie was initially given salbutamol tablets to take but they didn’t help. A different doctor tried her on steroid tablets which were very effective but Julie didn’t realise her symptoms could come back.
Stephen has recently been given inhalers to try, and he will return to see the GP in a few weeks. If they have helped the symptoms the doctor can be surer of the diagnosis.
Charles saw his GP about a chest infection and recurring wheeziness and was diagnosed with asthma. He was given salbutamol (Ventolin) to inhale, which improved the symptoms. [Text only]
GPs may recognise asthma symptoms, or they may look at other explanations first. As other conditions such as anxiety, infections and even heart problems can cause breathlessness, the GP may explore these first. People may be given an inhaler to try out immediately, or they may be given an antibiotic or other medication to try before inhalers are suggested. Sometimes where symptoms are severe and persistent the doctor may prescribe steroid tablets and/ or antibiotics to improve things quickly, before moving to try inhalers, or a combination of both types of treatment.
Peter (below) went to the doctor because of a chest infection:
Peter was initially treated for a chest infection but after taking antibiotics which didn’t clear things up doctors realised he had probably developed asthma too.
For some people, like Margaret, a sudden onset of severe symptoms led to a diagnosis.
Margaret had a persistent cough and was diagnosed with pneumonia. Her symptoms became so bad one night that she went to the hospital for emergency treatment and was told that it looked like she also had asthma.
Margaret had had less severe symptoms for a while beforehand, but in others like Mark who had childhood onset a sudden and frightening severe attack may be the first sign of asthma.
Asthma can be difficult to diagnose, particularly because it may not be clear whether the symptoms are caused by asthma or something else, and they often vary over time. It can improve greatly, and it can also get worse, sometimes for no obvious reason. Some people had found it hard to get a diagnosis initially. A few felt doctors were slow to realise the cause of their symptoms.