Clinical and Allergic Evaluation of the Patient with Bronchial Asthma

A diagnosis is usually in the details. Asthma is primarily an inflammatory disease of the bronchi with a bronchospastic component. The symptoms of bronchial asthma will suggest a wide variety of clinical conditions; the history is critical in defining etiology. The history should focus on seasonality, associated factors, current medications and other illnesses under treatment. Anosmia (loss of sense of smell) and/or hyposmia (a reduction in an ability to smell) are frequently symptoms of sinusitis with consequent asthma. Aspirin/Nsaid sensitivity suggests triad asthma, i.e., nasal polyps/asthma/ Nsaid sensitivity. Physical exam focuses on the nasal airway, i.e., polyps, turbinate swelling, septal perforation, and the chest, i.e., wheezing and degree of expiratory obstruction. Even in patients with a clear chest, a spirometric study is critical in assessing acute/chronic respiratory complaints to define the degree of obstruction. Sinus radiographs, i.e., sinus CT and x-rays, are underutilized in defining sinusitis as an etiology for acute and chronic asthma. An assessment of IgE mediated sensitivity, i.e., allergies, should be conducted in any asthmatic with a seasonal/exposure related history not only to confirm the diagnosis but also to initiate appropriate environmental control. Food sensitivity is rarely a cause of bronchial asthma. Recurrent cough/wheezing in an older/obese patient suggests G-E reflux even in the absence of upper GI complaints.