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Monday, March 10, 2014
Diagnosis of Asthma
My 10 year old son has been diagnosed with mild intermittent asthma. He has been put on Flovent twice a day/ 2 puffs. His only symptom was coughing/wheezing that lasted a week. An albuterol inhaler was prescribed but it was not effective. He was given a spirometry test, peak flow, and pulse ox reading by a medical assistant two weeks after this episode. Should I consult a specialist in the field rather than pediatrician? His pediatrician says no. However I wonder if my son really has asthma?
Asthma is a very common (roughly 5-10% of children) illness that is the result of chronic inflammation of the airways. Symptoms occur when these irritated airways become "triggered" by one of a number of factors (colds being an especially common trigger.) Once triggered, the airways launch into a complicated response of muscle constriction, swelling of the airway wall, and mucus overproduction. These changes cause symptoms that can range from persistent cough, to frank wheezing, to severe difficulty getting air.
Diagnosis is based on recognizing an asthma "pattern" in a patient, rather than on a single test. Typical symptoms, triggered by typical triggers, responsive to typical medications are part of that pattern. (Note, though, that albuterol alone will not always "fix" matters in a more persistent flare up - it only relaxes the muscle constriction; it does nothing for the airway swelling or mucus production.) Breathing tests that show abnormal airway function can also support the diagnosis - although even they are not a "perfect" test, because many asthmatics will have totally normal breathing tests when they are well.
Most children with asthma can be successfully treated by their primary care doctor. The most common reason to see a specialist is for consultation about asthma that won't come under control - the patient keeps having symptoms despite what's already been prescribed. (This situation raises questions of whether a more effective treatment plan is available, or whether a different problem is involved that hasn't been addressed yet.)
Asthma treatment is most successful when it is a team project between patients, families and physicians. When there is doubt about the diagnosis, it is hard to have everyone "on the same page." It can be helpful to have specialist involvement in this situation, to help clarify the diagnosis and help get everyone on track together.
Elizabeth D Allen, MD
Clinical Associate Professor of Pediatrics
College of Medicine
The Ohio State University