Diagnosis by an Asthma and Allergy Specialist

The asthma and allergy specialist makes a diagnosis of asthma based upon your medical history, physical examination, lung function, and allergy skin tests. Your specialist may also order other lab tests and X-rays if necessary. Asthma symptoms can change from day to day; you may not have any coughing, wheezing, shortness of breath, or chest tightness when you go into the office, so your doctor will rely on the history of these symptoms, when and how often they occur, and how much they bother you. Don't worry if you don't have symptoms the day you see your allergist. If you are already taking asthma medications, don't stop them unless told to do so by the specialist's office.

What to Expect

You will first be asked detailed questions about your medical history and you'll review your allergy and asthma symptoms, the development of the disease, what happens during a typical episode and what you may know to be triggers. The doctor will also review your living situation, home and work environments; family history; and the impact of asthma on you and your family. Be prepared to answer detailed questions about what you are exposed to in your home and work environment on a daily basis. The medical history is the most important piece of information that your asthma and allergy specialist will obtain -- even more important that the physical exam and tests. Be sure to give the specialist all the information that you have about your asthma and/or allergies.

The doctor will then do a physical exam with emphasis on your eyes, ears, nose, throat, lungs, and skin. You may have signs of allergy or sinusitis that could affect your asthma and make it worse. The physical examination of the lungs may be totally normal, even with moderate or severe asthma, so more objective lung function tests may necessary to access the severity of the asthma condition.

Lung Function Test (Spirometry)

Spirometry measures lung volumes and air flow rates out of the lungs. A spirometer is a computer that is able to provide objective measurements of lung function. All suspected asthmatics, except infants and very young children, should have spirometry performed during your first visit to an asthma specialist and periodically thereafter. If you've been diagnosed with asthma, but have never had a lung function test, ask your primary care doctor to refer you to an asthma and allergy specialist to have a lung function test performed, especially if your primary care physician is unable to perform a spirometry test in his/her office.

Here's what to expect during spirometry testing:

• Take a deep breath and fill up your lungs completely.
• Blow hard and fast into the spirometer. Blow as long as you can and be sure that all the air is forced from your lungs. The nurse or respiratory therapist will coach you on the proper way to do this.
• You will be asked to repeat this until three acceptable measurements are performed.

The spirometer is measuring the volume of air you are blowing out of the lungs over a certain length of time, usually in seconds. Your lung function test results will be used to diagnose and stage your asthma and make appropriate treatment recommendations.

Peak Flow Monitoring

If you are diagnosed as having mild persistent, moderate persistant, or severe persistant asthma you will be shown how to use a peak flow meter while still in the asthma and allergy specialists' office. Depending on the status of your asthma at the time, you will be given expected ranges that will correspond to the "zones" of your Asthma Action Plan. You will then be asked to monitor your peak flow for a few weeks and the zones may be reset as your asthma improves. Always bring the results of peak flow tests you've been checking on your own when your return to the doctor's office for check-ups.

Allergen Skin Testing

Your doctor may do a skin test to identify what allergies are making your asthma worse. Reports suggest that up to 75 to 85 percent of asthmatics have positive skin test reactions. For more information about allergies, testing, and allergens, see the section in Triggers.

Other Tests

Your doctor may also perform any or all of the following tests:

• Sinus X-rays or C-T scans to check for sinusitis
• Chest X-rays
• Other special tests including complete blood count, sputum and nasal secretion examination, fiberoptic scoping of your nose and throat (rhinolaryngoscopy), special lung function tests, and tests to consider the possibility of gastroesophageal reflux disease (GERD).

Your first visit to an asthma and allergy specialist is your first step in controlling your asthma. Your specialist will take the results of your visit and recommend a plan of action -- the goals of your care. Together, you'll plan ways to decrease your triggers and find the right medications so that you can sleep through the night, participate in activities and exercise, rarely have symptoms, and don't have symptoms that send you to the emergency room or hospital. Talking over your concerns, goals for therapy, quality of life, and expectations will provide a good base for the partnership you are developing with the asthma and allergy specialist and your doctor's team.

Take this short quiz before going to see your doctor. It may help prepare you with questions you may have for your asthma and allergy specialist.