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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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If you are having an asthma attack, your health-care professional (whether your primary-care provider or an emergency-department physician) will ask you questions about your symptoms, medical history, and medications. Answer as completely as you can. He or she will also examine you and observe you as you breathe.

He or she will assess the severity of the attack. Attacks are usually classified as mild, moderately severe, or severe. This assessment is based on several factors.

• Symptom severity and duration



• Degree of airway obstruction



• Extent to which the attack is interfering with regular activities

If you have had symptoms and are seeking medical care afterward, the health-care professional will ask questions and perform tests to search for and rule out or exclude other causes of the symptoms. The evaluation will almost certainly include tests of how well you can breathe at rest and may include tests during exertion. These tests are done at rest, after six to eight minutes of exercise, and then at regular intervals until at least 30 minutes after you have stopped exercising. Proper diagnosis is essential to ensure that the most appropriate treatment is given.

Measurements of how well you are breathing can be assessed using the following methods:

• Spirometry: The spirometer is a device that measures how much air you can exhale and how forcefully you can breathe out. The test may be done before and after you inhale a medication. Spirometry is a good way to see how much your breathing is impaired during an attack. This test must be done in the medical office; you may exercise on a treadmill or stationary bicycle.



• Peak flow meter: This is another way of measuring how forcefully you can breathe out during an attack. This device is small and portable and can be used "in the field." This allows testing after six to eight minutes of your usual activity.



• Oximetry: A painless probe, called a pulse oximeter, may be placed on your fingertip to measure the amount of oxygen in your bloodstream.

No blood test can pinpoint the cause of asthma.

• Your blood may be checked for signs of an infection that might be contributing to the symptoms.



• In severe attacks, it may be necessary to sample blood from an artery to determine exactly how much oxygen and carbon dioxide are present in your bloodstream.

A chest x-ray may also be taken. This is mostly to rule out other conditions that can cause similar symptoms.

In many instances, the history is the most important clue to the diagnosis of exercise-induced asthma. Oftentimes, armed with this information, the health-care professional will empirically trial a medication for exercise-induced asthma. Follow-up visits will then determine if this medication was effective in reducing the symptoms associated with exercise.

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