Your Medical History - Diagnosing Asthma: Adult Asthma

Content provided by the Faculty of the Harvard Medical School

Your medical history

To diagnose asthma, your doctor will ask you detailed questions about your respiratory symptoms and other aspects of your medical history. If you are coughing, are you coughing up clear sputum? That is common in asthma. Do you have a fever, and are you coughing up opaque, discolored sputum? That would be unusual for asthma but common in a respiratory tract infection such as bronchitis or pneumonia. Do the symptoms awaken you at night? Asthma often worsens in the early-morning hours, but so do other respiratory diseases. Do you experience a noisy whistling with your breathing, especially while breathing out, a wheezing that does not go away after you've coughed up some sputum? People with asthma have said that they thought they heard sounds of a cat or a chirping bird, only to discover that their own breathing passageways were making that musical sound! Other symptoms of asthma may include tightness around the chest, as if a giant rubber band were constricting your breathing, and itching under the chin in the absence of a rash.

The doctor will also want to know about all the things that make your breathing better or worse. Some factors may not be specific to asthma. For instance, many people complain that they find it hard to breathe in very hot and humid weather or in smoke-filled rooms. You may have had these reactions, but so too would someone with emphysema, heart failure, or pulmonary fibrosis.

On the other hand, there are characteristic asthma triggers that might explain your recent symptoms and point to a diagnosis of asthma. Do your symptoms worsen if you work in a horse barn, play with a cat or dog, dust at home, or exert yourself on a cold day? Does taking aspirin, ibuprofen, or naproxen provoke your symptoms? Do sulfites (found in wine, beer, and some foods) trigger symptoms? Have you recently started any new medications (such as a beta blocker for your heart or for high blood pressure)? Has your house been overrun by roaches or mice? If you answer yes to any of these questions, the diagnosis may well be asthma.

Other questions from your doctor may provide some circumstantial evidence for or against asthma. Do you have any allergic diseases — hay fever, hives, or eczema, for example? These conditions point to an allergic tendency (see "The allergy connection") that would weigh in favor of asthma. Similarly, a strong family history of allergies and asthma would add to the likelihood that your symptoms are due to asthma. On the other hand, if you have smoked for 20 years or longer, your doctor will suspect emphysema or chronic bronchitis, rather than asthma (see "COPD").

Last updated:	September 27, 2007