|
|
|
What to expect at the doctor’s office
If you’re wondering about your child’s cough,
chest tightness or other symptoms, take them to a physician, and expect the
following. Asthma can be difficult to diagnose, particularly in very young
children, and so it is critical that your physician be knowledgeable in the
diagnosis and treatment of asthma. Ask them if they are familiar with best
practice information from either the:
- Expert Panel Report 2 of the National Asthma
Education and Prevention Program (from the National Institutes of Health) or
- the Pediatric Asthma Guide, released in 1999.
The Pediatric Asthma Guide is endorsed by the American Academy of
Pediatrics, the American Academy of Allergy, Asthma and Immunology, and the
National Heart, Lung and Blood Institute.
In order to make a diagnosis of asthma, the
physician will be looking to:
- Understand the symptoms of airflow obstruction
(coughing, wheezing, shortness of breath, rapid breathing, or chest
tightness)
- Rule out other possible diagnoses
- Determine if the airflow limitation is at
least partially reversible
So, what should you expect at the doctor’s
office?
To determine if your child’s symptoms
indicate asthma, the doctor should 1) take a thorough medical history, 2)
conduct a physical examination and 3) ideally, perform spirometry.
Medical history: questions your doctor should
ask.
Because an accurate medical history is so
pivotal, the more detailed you can be, the better. See if you can think about
these questions beforehand.
- Is there a family history of allergy and/or
asthma?
- What are the child’s symptoms? When did you
first notice them? When do they occur? What causes symptoms? What makes
symptoms worse (smoke, exercise, allergens, humidity, crying/laughing,
etc.)? Any pattern to them?
- What are the frequency and severity of the
symptoms? Do symptoms interfere with daily activities? Do symptoms limit
physical activity? Do symptoms disrupt sleep? Do symptoms affect school
performance or activities? Has the child needed to go to the emergency room
or hospital because of symptoms?
- How are the symptoms currently managed?
The physical exam
Listening to your child’s lungs with a
stethoscope can be very telling and reveal distinctive sounds. Wheezing and
struggling for breath will also often leave physical evidence. Your doctor
should check the child for hyperexpansion of the thorax. A doctor may also look
for other signs of allergic disease like dermatitis/eczema, swelling of the
nasal passages, pale nasal mucosa and clear nasal discharge.
Objective measurements
If the physician suspects asthma after questioning and physically examining
the child, he/she should test
the airway and lungs during that initial visit
using spirometry. Spirometry is an objective way to evaluate the air capacity of
the lungs by measuring the volume of air exhaled before and after using a
bronchodilator (or "inhaler"). It is not invasive and does not hurt
your child. A spirometer is a machine that has a hose attached to the end of it.
The child blows forcefully into the hose to register a reading.
Spirometry involves the following steps:
- The child exhales and the spirometer measures
the airflow, comparing lung capacity to the normal capacity for the child’s
age and racial group.
- The child then inhales medicine from a
short-acting bronchodilator.
- The doctor takes another measurement of the
lung capacity. An increase in capacity suggests that asthma symptoms can be
reversed.
- A doctor should have the child perform some
physical activity to increase breathing and check for changes in lung
capacity with and without use of the bronchodilator.
This test can tell the doctor if there is a
significant impairment to the airway and if treatment can reverse the problem.
Children generally need to be at least five years old to carry out this test
successfully.
Allergy testing
There are four classifications of asthma:
mild intermittent, mild persistent, moderate persistent and severe persistent.
If your doctor feels your child has persistent asthma, allergy testing should be
done. Approximately 70 - 90% of children with asthma have allergies and these
allergies can greatly exacerbate asthma symptoms. Knowing what a child is
allergic to can allow you to take important environmental control measures.
Allergy testing requires expertise. So, if your child needs to be tested,
consider getting a referral to or consultation with an allergist or asthma
specialist.
An allergy test can be performed in a few
different ways:
- Scratch or puncture test - An allergen is
scratched across or lightly pricked into the skin. If an allergy exists, the
skin will show evidence of allergic reaction by producing a small, raised
area.
- Intradermal test - An allergen is injected
under the skin and again the skin is examined for evidence of a reaction.
This test may be needed if the scratch test results cannot be determined.
- Blood test - A blood test is usually used when
a skin test is not possible.
In addition to making the proper diagnosis, your
doctor should also educate you on the disease and provide you with take-home
information. They should involve the family and others close to the child, act
as a constant resource and help treat the diagnosed asthma as children can have
a difficult time managing asthma. A doctor can make the child more comfortable,
knowledgeable and, of course, much healthier.
This article was written and medically reviewed:
March 31, 2000
Information for this educational article was
derived from the document:
Pediatric
Asthma: Promoting Best Practice Guide for Managing Asthma in Children
Known as the Pediatric
Asthma Guide for short, it represents the collective work of many people and
many organizations. It is the only document for treating childhood asthma that
is endorsed by the American Academy of Allergy, Asthma and Immunology, the
American Academy of Pediatrics, and the National Asthma Education and Prevention
Program (NAEPP) of the National Heart, Lung, and Blood Institute. The Guide is
based on guidelines developed by the NAEPP. This pediatric initiative adapted
those guidelines into an easily-referenced, user-friendly, pediatric-focused
document for medical professionals.
The Guide is but one part of a larger initiative
committed to ensuring that a broad spectrum of health care providers learn
about, understand and implement clinical and best practice information for
diagnosing and managing children with asthma.
<back>
|
