Expert: Marc Rubin, RPh Asthma Educator - 10/13/2010

Question
Dear Marc Rubin

how to diagnose a person who have asthma? i have problem of allergic rhinitis, post nasal drip, and shortness of breath, can post nasal drip effect the chest, i visited a doctor who said i have no problem of asthma, because i have no cough, no wheezing.

Zafar Iqbal

Answer
Hello Zafar,

The diagnosis of asthma is made from an evaluation based upon a number of factors:

-family history of asthma, and/or allergies

-cbc w/differential, looking specifically at eosinophils...a marker for allergic response. This is more an indicator in a child or young adult. In adult onset, allergies are generally not the issue, but irritants, such as smoke, industrial chemicals, particulate matter (diesel engine emissions, factory pollution, etc.), ozone, and the list goes on.

-the most critical test, and the one that is truly diagnostic is spirometry. This is done with a piece of computerized equipment whre you are breathing in deeply, then rapidly, and completely blowing out as hard as you can. It is repeated at least 3 times for the goal of getting two nearly identical readings. Then you are generally given a breathing treatment with salbuterol. The test is then repeated. If the change after the breathing treatment is greater than 12%, or the volume increase is greater then 200ml, you have asthma.

-one exception to this. If, when you are taking the test you and are not having any breathing issues, the change may not be significant. In this case the doctor may run a methacholine challenge. This is generally more common to run in adults. In a patient with asthma, it will trigger a lung spasm.

Now, in regards to triggers for asthma, allergic rhinitis, which is what you suffer from, can indeed trigger of the lungs. THe best way to resolve this is using nasal steroid sprays. By reducing the sinus inflammation, you reduce the risk of bronchospasm in the lungs. Technique is very important so you do not develop a bloody nose, or a fungal sinus infection. You spray towards the outside of the nostril flare, or straight back against the back wall of the nose. You then sniff gently. Don't blow your nose for 15 minutes. Never spray straight up into the sinuses.

Hope this helps you. The fact you are not coughing or wheezing is not the complete diagnostic criteria.

Oh, do you find yourself waking up in the middle of the night with shortness of breath? That would be of grater significance.


Hope this helps,

Sincerely,

Marc