Bronchial asthma is considered a serious illness of the respiratory system. The symptoms of this ailment can be confused with the manifestations of other diseases, therefore, the doctor often fails to establish the correct diagnosis the first time, especially at the onset of bronchial inflammation.

All doubts can be dispelled and assumptions can be confirmed only after collecting the patient’s history, receiving test results and diagnostic procedures. Only in this case the doctor will be able to diagnose and choose an effective treatment tactics.

The diagnosis of bronchial asthma is considered accurate if all the classification signs are displayed in the formulation. In particular, this applies to the form of the disease, phase, its severity. If there are complications, then they must also be indicated.

Bronchial asthma

The most common ailment of the respiratory system is a chronic bronchial disease called asthma. A characteristic feature of this disease is inflammation of the airways, which entails their hyperreactivity.

Typical AD symptoms are a non-productive dry cough and shortness of breath. In the clinical diagnosis of bronchial asthma, it is important to prevent an asthma attack that develops due to bronchospasm and narrowing of the airways.

An asthma attack most often develops at night. Its onset can be suspected by the appearance of shortness of breath, cough, hoarseness and wheezing sounds during breathing. As a rule, it proceeds in different ways, it can go away in a few minutes or a few days.

The importance of correct formulation of AD diagnosis

The wording of the diagnosis for bronchial asthma is clearly and competently. This requirement should be met for several reasons.

1. First, the correct choice of the course of treatment depends on the correctness of the diagnosis. Only with correct treatment, the risk of developing a severe stage of the disease decreases.
2. Secondly, the doctor examines the history data and the results of clinical examinations of the patient. When formulating an accurate diagnosis, the doctor separates bronchial asthma from other diseases with similar symptoms.  
3. Thirdly, filling out documentation with a clear formulation of diagnoses makes it possible to keep statistics on diseases and mortality.
4. When filling out the documentation, doctors should take into account that clear information about the disease is necessary to solve financial issues of insurance medicine. The amount of free medical care depends on the diagnosis.
5. A clearly prescribed diagnosis with all the details of the course of the disease is necessary if the patient goes to another hospital or wants to consult another doctor.

Also, do not forget that a clear diagnosis in an outpatient card or medical history is an indicator of the quality of the doctor’s work.

Classification criteria

In bronchial asthma, the formulation of the diagnosis indicates such characteristics as the form of the disease, its stage, phase and complications. The need for classification is explained by the fact that this chronic disease can proceed in different ways, and depending on this, treatment methods are selected.

As with any other disease, doctors use the ICD document when making a diagnosis for patients with respiratory diseases. In this classification, certain types of AD are distinguished based on two criteria:

• nature of origin;
• the severity of the course.

Many experienced specialists consider such division to be insufficient, therefore they try to apply a different approach to the classification of the disease. Particular attention is paid to the following points:

• the severity of the disease before treatment;
• the body’s response to ongoing therapy;
• control of the course of the disease: is there a chance of achieving remission or reducing the number of attacks;
• is there a connection between the features of BA and its causes;
• for what reason complications develop.

Etiological classification of the disease

For the treatment to be as effective as possible, it is important to identify the true cause of the development of the disease. For example, if you eliminate the provoking factors of allergic asthma, you will be able to achieve a stable remission. 

Depending on the cause of the occurrence, three forms of the disease are distinguished:

1. Allergic BA. Typically, the attack and frequent dry cough is caused by an external irritant, such as a food or respiratory allergen. We often have to deal with the effects of several stimuli. Airborne allergens include household dust, plant pollen, tobacco smoke, particles of animal skin, and more. Initially , allergic rhinitis, tracheitis, sinusitis, or laryngitis develops. Later, against the background of these diseases, bronchial asthma appears. 
2. With the development of an infectious-dependent form of the disease under the influence of pathogenic microorganisms, the patency of the bronchi changes. The patient is disturbed by symptoms such as dry cough, shortness of breath, asthma attacks. Fungi, bacteria and viruses can provoke the development of the disease. They also cause frequent exacerbations.
3. Mixed flow asthma. In this case, the respiratory lumen narrows not only when interacting with the allergen, but also under the influence of external factors. Often, a mixed course ailment develops due to poor ecology, unfavorable climatic conditions, as well as against the background of exposure to chemical irritants, addictions and stress.

Considering the examples of the formulation of the diagnosis of bronchial asthma, it should be noted that, if necessary, special forms of the disease of mixed genesis are distinguished:

• occupational asthma occurs when exposed to certain chemicals in the workplace. Due to the hyperreactivity of the bronchi, a person develops frequent coughing and asthma attacks. The risk group includes people working in libraries, hairdressers, pet shops, pharmacies, bakeries, etc.;
• BA of physical stress. In this case, bronchospasm occurs during physical work or after it. You can pinpoint this problem if you rule out other causes. Many experts believe that this factor is not the cause of the development of the disease itself, it only provokes the onset of AD symptoms.

Classification by the severity of the course

To prescribe an effective treatment, the doctor must establish the severity of the disease. This is done after identifying the cause of pathological changes in the bronchi.

When asthma is diagnosed, the severity must be indicated in the diagnosis. To characterize, the doctor evaluates certain parameters:

1. Frequency of attacks day and night.
2. Features of the course and duration of the attack.
3. Impact of BA exacerbations on the patient’s quality of life.
4. External respiration indicators.

As a result of such an assessment, the type of disease course is determined:

• intermittent asthma – attacks can occur during the day about once a week, and at night – a maximum of twice a month. The exacerbation of the disease does not last long, while the symptoms may not bother for several months or years;
• persistent asthma is mild, moderate, or severe. The disease is characterized by frequent attacks that occur at any time of the day. Exacerbations last a long time, while the emotional and physical condition of the patient worsens. Motor activity and sleep are also impaired.

Disease control level

To select the appropriate treatment method and adjust it, the physician must take into account the patient’s response to the therapy previously used.

If the medications were selected correctly, then in patients with a disease of moderate severity and severe course, there is an improvement in external respiration.

By the level of BA control it happens:

• well controlled;
• partially controlled;
• uncontrolled.

If the disease cannot be controlled and the symptoms progress, the doctor must determine the reason for this. For this, the following factors are being revised:

• whether the patient’s lifestyle has changed;
• whether the allergen has been eliminated;
• does the patient follow medical recommendations;
• whether the influence of provoking factors (excessive physical activity, dirty air, smoking) is limited;
• whether attacks with infectious diseases became more frequent;
• is there an exacerbation of any disease of the chronic course.

Special forms of bronchial asthma

In a separate category that does not fall into the classification, experts attribute the cough form of the disease. In another way, it is called the latent form.

A common symptom is a dry or wet cough, which can also be a symptom of other respiratory problems. For this reason, the disease is difficult to recognize at an early stage of development.

In medicine, there is also such a thing as aspirin asthma. It is found in asthmatics in 6% of cases. The pathogenesis of this form of the disease is not fully understood, it is only known that it is associated with intolerance to acetylsalicylic acid and salicylates. 

Flow phases

Based on how often the symptoms of bronchial hyperreactivity appear and how often attacks occur, BA is divided into the following phases:

• exacerbation of the disease;
• remission (it is considered stable if symptoms disappear for at least two years)

Depending on the presence of complications, AD can be complicated or uncomplicated.

Rationale for a diagnosis of asthma

The diagnosis of “bronchial asthma” at the prehospital stage is made on the basis of patient complaints and anamnesis of the disease. The rationale for the diagnosis is provided by the results of clinical tests and diagnostic examinations carried out with suspicions of the development of bronchial asthma.

If asthma symptoms such as asthma attacks, shortness of breath, coughing, wheezing and whistling when breathing are found, then this will be the reason for referring the patient to a narrow-profile specialist – a pulmonologist.

Since the disease can occur with various accompanying symptoms, you cannot do without consulting an allergist, gastroenterologist and cardiologist. Only with a comprehensive diagnosis, the diagnosis of bronchial asthma can be confirmed.

One of the proven methods for detecting disease is the spirometry procedure. When it is carried out, violations of the functions of the respiratory system can be detected. The fact is taken into account that bronchial lumens narrow in AD, which interferes with the flow of air into the lungs. The spirometry results describe important parameters that enable the pulmonologist to make an accurate diagnosis. The specialist pays special attention to the forced expiratory volume and the forced vital capacity of the lungs.

An important point in the diagnosis of the disease is the tapping of the chest. By doing this, the pulmonologist can hear high-pitched sounds. This suggests that the lungs of asthmatics are full of air. In addition, the presence of wheezing during inhalation and exhalation is considered a reason for a preliminary diagnosis. But only an experienced specialist can classify them.

The list of diagnostic procedures may include bronchial radiography. She is appointed if the doctor has doubts about the correct diagnosis. Through chest X-ray, pathological changes in the bronchi and lungs can be seen. In some cases, it is enough to undergo fluorography.

The development of bronchial asthma can also be confirmed by the results of blood tests, urine and sputum excreted during a coughing attack. The fact that IgE antibodies are present in the blood will help to confirm the preliminary diagnosis . In order for the research results to be as accurate as possible, the patient must refrain from drinking alcohol and taking medications the day before.

If it becomes necessary to undergo an additional examination and take tests after visiting a doctor, then this must be done as soon as possible. In the worst case, the clinical picture will be blurred. A quick diagnosis of bronchial asthma increases the chances of a speedy recovery.  

Diagram of the formulation of the diagnosis of bronchial asthma

All doctors adhere to the general rule of formulating the diagnosis of bronchial asthma. The form of the disease, the severity, phase and the presence of certain complications, if any, are indicated without fail.

An example of the correct formulation of the diagnosis of bronchial asthma looks like this:

• bronchial asthma of atopic form, moderate severity, phase of dying exacerbation. Concomitant diagnosis: recurrent urticaria;
• bronchial asthma of infectious-dependent form, severe course, exacerbation phase. Complications: purulent bronchitis, pulmonary emphysema, 2nd degree of pulmonary insufficiency.

You can also find the following wording:

• allergic bronchial asthma, amenable to partial control, is in an exacerbation stage. Additionally – mild rhinitis, conjunctivitis;
• endogenous bronchial asthma, uncontrolled, in the stage of severe exacerbation. Background diagnosis: non-erosive form of gastroesophageal reflux disease.

Finally

It is impossible to accurately make a clinical diagnosis of bronchial asthma only on the basis of patient complaints. Many symptoms may indicate the development of other ailments of the respiratory system.

For example, heavy breathing, coughing, and wheezing can be heard in bronchitis, and symptoms of inflammation are also seen in pneumonia. To draw the correct conclusions, the doctor prescribes additional examination methods that make it possible to diagnose by excluding other diseases.