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11/2/06 Diagnosis of asthma in adultsSummary Findings - Diagnostic aspects of asthma in adults were reviewed by Marshall of the Univ of Mississippi. He emphasized that not all asthma in adults is manifested by wheezing and not all wheezing is due to asthma. Up to 15% of adult- onset asthma presents with chronic cough without other manifestations. Wheezing on exertion or/and on exposure to aeroallergens and associated chronic non-infectious rhinosinusitis are clues pointing to possible asthma as are precipitation of wheezing/cough by respiratory infections or GERD. A past history of childhood asthma and/or parental asthma are other clues. The possible relationship of wheezing/cough occurrence to occupational exposure should be investigated. Pertinent findings on physical exam include prolonged expiration, wheezing (sometimes heard only at end-expiration), signs of chronic rhinitis or chronic eczematous dermatitis. The differential diagnosis of asthma in adults includes: 1) COPD - history of smoking, hyperinflated chest, irreversible airway obstruction; 2) vocal cord dysfunction - acute episodes of dyspnea with dysphonia; 3) congestive heart failure - crackles as well as wheeze on exam; 4) GERD and post-nasal drip in some cases of chronic cough. Office spirometry, including responses to inhaled albuterol are key in establishing a diagnosis of asthma. When screening spirometry findings are normal in face of a clinical picture highly suggestive of asthma, more sophisticated pulmonary function testing may be indicated. Reference Editor's Comments
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