Tools in Asthma Evaluation and Management: When and How to Use Them?

Abstract

The goals of asthma management are accurate diagnosis, prompt initiation of treatment and monitoring of disease progression to limit potential morbidity and mortality. While the diagnosis and management is largely based on history taking and clinical examination, there are an increasing number of tools available that could be used to aid diagnosis, define phenotypes, monitor progress and assess response to treatment. Tools such as the Asthma Predictive Index could help in making predictions about the possibility of asthma in childhood based on certain clinical parameters in pre-schoolers. Lung function measurements such as peak expiratory flow, spirometry, bronchodilator responsiveness, and bronchial provocation tests help establish airway obstruction and variability over time. Tools such as asthma questionnaires, lung function measurements and markers of airway inflammation could be used in combination with clinical assessments to assess ongoing asthma control. Recent advances in digital technology, which open up new frontiers in asthma management, need to be evaluated and embraced if proven to be of value. This review summarises the role of currently available tools in asthma diagnosis and management. While many of the tools are readily available in resource rich settings, it becomes more challenging when working in resource poor settings. A rational approach to the use of these tools is recommended.

Association of childhood croup and increased incidence of airway hyperreactivity in adulthood

“…Exposures for asthma include exercise, infection, allergens, occupational exposures, and airborne irritants. [ 13 ] In the United States, the prevalence of asthma has increased from 7.3% in 2001 to 8.4% in 2010. [ 14 ] The prevalence of asthma among Iranian children varied from 1.26% to 11.6%.…”

Asthma Management in the Era of the COVID-19 Pandemic

“…There are opportunities to help improve the efficiency of virtual clinics by using various well-known tools of asthma management [ 38 ]. During the physical exam of a child with asthma, the evaluation of comorbidities such as allergic rhinitis, obesity, tonsillar hypertrophy, and eczema is vital.…”

Special Considerations in Preschool Age

“…The Asthma Predictive Index (API) is a clinical tool used to evaluate a wheezing preschooler's risk of later asthma. After providing information on the number of wheezing episodes, parental asthma, current eczema, rhinitis, and eosinophilia, the treating doctor obtains either a positive or negative result that indicates the likelihood of their patient developing asthma and can use it as a basis for treatment based on the GINA guidelines [132]. mAPI, the modified Asthma Predictive Index, is even more accurate compared to API in predicting asthma correctly when obtaining a positive result, with the addition of criteria such as parent's allergy to airborne allergen and patient's allergy to foods such as egg, milk, or peanuts [133].…”