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Clinical Presentation
Symptoms are usually associated with airflow obstruction, which is often reversible, either spontaneously or with treatment. These symptoms tend to be >1 type of respiratory symptom, intermittent, variable, worse at night or upon waking, and provoked by triggers such as exercise, allergens, irritant exposure, weather changes, drugs, or viral respiratory infections.
History
It
is essential to get the patient’s personal or family history of other atopic
conditions (eg allergic rhinitis, eczema). Worsening of symptoms after exposure
to common triggers (eg pollen, dust, exercise, viral infections, tobacco and
e-cigarette smoke, Aspirin or nonsteroidal anti-inflammatory drug [NSAID],
weather changes) should also be noted in the history taking. It is important to
remember that bronchoconstriction induced by exercise usually occurs 5-10
minutes after completing the exercise. Symptoms improved by appropriate
anti-asthmatic treatment should also be taken note of.
Consensus-based Global
Initiative for Asthma (GINA) symptom control tool (see below table) may be used
to assess the control of asthma. Useful together with risk assessment for
treatment decision-making, may refer to Risk Factors section for
the Risk Factors for Poor Asthma Outcomes.
| ASSESS THE LEVEL OF CONTROL OF ASTHMA (FOR THE PAST 4 WEEKS) | |||||
| |
Well Controlled (All of the following) |
Partly Controlled (Presence of 1-2 of these) |
Uncontrolled (Presence of 3-4 of these) |
||
| Frequency of daytime symptoms | None | >2x/week | >2x/week | ||
| Limitation of activities | None | Any | Any | ||
| Nocturnal waking up or coughing due to asthma | None | Any | Any | ||
| Need for reliever medication* | None | >2x/week | >2x/week | ||
| *Reliever medications taken prior to exercise excluded. Reference: Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention: Updated 2024. |
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Asthma control may also be assessed using different validated measures such as the asthma control test (ACT), childhood asthma control test (C-Act), asthma control questionnaire (ACQ), asthma therapy assessment questionnaire (ATAQ), or asthma control scoring system. It may improve the assessment of asthma control, provide reproducible objective measures, and allow better communication between physicians and patients.
The asthma control test is a self-administered instrument that considers the frequency of the patient’s activity limitations, shortness of breath and night-time symptoms, use of rescue medication, and rating of the overall control of the disease within the past 4 weeks. The use of asthma control test for treatment response monitoring in a resource-limited setting has been found to be accurate and feasible. The sum of the factors considered will determine the level of the patient’s asthma control and the management appropriate for the patient.
Physical Examination
Because asthma symptoms are variable, the physical examination of an asthmatic patient may be normal. Nevertheless, if the patient is examined during the symptomatic period, they may present with dyspnea, hyperinflation, and expiratory wheezing. Wheezing may be absent (silent chest), especially during severe attacks. Chronic asthma sufferers may have signs of hyperinflation with or without wheezing. Allergic rhinitis or nasal polyposis may also be seen during the examination of the nose.