Asthma

Being diagnosed with asthma

It may take some people a long time to recognise a pattern of symptoms they have been experiencing over time. Some people didn’t notice or pay attention to their own symptoms but friends or family may have recognised the possibility and suggested visiting the GP.

A GP explains what happens when someone attends the surgery with symptoms of asthma

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As a GP if somebody comes to you presenting symptoms of asthma what is your course of action, what would you do?

Right. I mean first of all one has to make a proper diagnosis if someone has some symptoms of asthma. So the symptoms may be of feeling tight-chested. There may be shortness of breath. They may be coughing a lot at night time. So there’s quite a lot of questions to ask at this point, you know, about what exactly the symptoms are they have been experiencing and particularly about any triggers they may have noticed. Does it come on when they go out in the cold? Is it exercise related? Are there particular things that seem to spark it off? You might also want to find out about whether there is any family history of asthma because it does rather run in families.

Having taken those details and probably had a listen also to the chest to see if there is anything else obvious going on. You’d probably want to do what’s called a peak flow measurement and that’s when you get the patient to blow into a tube as hard and fast as they can and that tells you how much air you can move from the lungs at the time. And if the airways are narrowed your peak flow is reduced.

Now the key feature of asthma is that it’s variable. Sometimes though the airways are narrowed and sometimes they are back to normal and that’s really what you are trying to find out when you are making a diagnosis. Is there this variability? So you would often ask the patient to take away a Peak Flow Meter with them and do some measurements at home at different times of the day. And also before and after using some treatment because if you do think it is asthma it’s a good idea to actually start some treatment there and then which will probably be a Ventolin inhaler, this is salbutamol and it’s a medicine that relaxes the muscles around the airways and helps them to open up. And what we classically see if someone has filled in what’s called a Peak Flow Diary is that sometimes they are achieving much higher peak flows than at others and that the Ventolin will help the airflow.

In our interviews people talked about what had led to their asthma diagnosis. They had been diagnosed at different times – childhood, adolescence and later in life. The paths to diagnosis were many and varied, and not always clear cut. It might take a series of events and possibly several visits to the GP before a firm diagnosis of asthma could be given. Typically people who went to see the GP with symptoms recalled the GP taking a history, asking if there were any instances of asthma within the family, listening to the chest, using a peak flow meter to test lung function. Sometimes they remembered being referred for other tests.

Val asked her GP to check her breathing. A Spirometry test showed her breathing was quite bad. Trying a preventive inhaler helped to reach a diagnosis

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Age at interview: 62

Sex: Female

Age at diagnosis: 57

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I went to the GP for something else, and I said, “While I’m here could you check my breathing?” and she kind of was a little bit dismissive at first. She, she examined my lungs and she, she you know, kind of did some on the spot things. But, in all fairness, she said, “Well, we’d better get you a spirometry test.” So she arranged that with the nurse and that happened within four or five days, something.

I had the spirometry test with the nurse and she kind of took the results but didn’t say anything and then she said to me, “Did the doctor ask to see you again?”

The doctor had given me a blue inhaler, but kind of hadn’t shown me how to use it. So the nurse actually showed me how to use the blue inhaler and then she said I should make an appointment, and go back and see the doctor. And the doctor actually got a graph of my breathing printed out for me to look at and kind of my breathing went underneath the line of the graph so I did have quite severe breathing problems. And she spent a long time discussing it with me, how I thought I might have got them.

Because I hadn’t, in fact, I used to smoke but only about five a week something and I finished in 1978 and after that I was really fit - I used to rock climb, mountain climb etc. and all I could put it down to was that I remember my first symptoms first starting when I lived in the country quite near here and they had sprayed fields behind the house - they used to spray fields every night. And there were three women of my age and we all kind of developed symptoms at the same time throats and hay fever and what have you.

So the doctor then asked me to go back. She put me on the brown inhaler which is a preventer inhaler and she put me on a very high dose. And she asked me to go back in two months’ time for what’s called a reversibility test to see whether your symptoms have improved on the preventer inhaler.

So I had that appointment in the January. So the first appointment was in the November and I had that appointment in the January - and I went back and they hadn’t improved at all. So, she referred me to the hospital to a consultant at the hospital and the consultants confirmed that I had got in fact, quite severe asthma, which unfortunately has actually got worse since then as well. So, I was put on a preventer inhaler and I was given kind of some advice about how to deal with the asthma.

The two most common tests that are used to help check lung function are Peak flow test, and Spirometry.

Peak flow test

A small hand held device called a peak flow meter is used to measure how fast you can blow air out of your lungs in one breath which indicates how much the airways are narrowed. Patients may be given a peak flow meter to take home and asked to keep a diary of measurements and symptoms. To make a diagnosis of asthma, the peak flow reading must vary over time or improve after treatment with an inhaler. The peak flow meter can also help people at home to monitor their condition themselves. (See ‘Managing asthma – reviews and action plans’).

When Alastair’s asthma was diagnosed he was given medication and asked to record his peak flow measurement for a period of time.

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Age at interview: 31

Sex: Male

Age at diagnosis: 10

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Well the first thing I knew about getting asthma was I was ten years old, and I was having trouble, we were doing cross country at school and I was having trouble with my breathing. So after about six months of this happening my parents took me to the GP and from what I can remember I was told that I had asthma. I was given two pumps. I think one was Beconase and the other one was Ventolin. And at being ten at time I can’t really remember too much about it. I remember being given a... it measures the volume of your lungs when you blow into it.

A peak flow meter.

A peak flow meter yes, and having to do a graph and chart and things like that.

Spirometry

This helps to assess how well the lungs are functioning. The spirometer measures the volume of air breathed out in one second, and the total amount of air breathed out. The readings are compared with normal measurements for your age, which can show if your airways are obstructed.

Val was referred to have a spirometry test when she visited the surgery with breathing problems.

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Age at interview: 62

Sex: Female

Age at diagnosis: 57

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It’s kind of a lung function test. There’s a lot of controversy because a lot of people don’t get an accurate diagnosis initially because they don’t have the test I’ve kind of learnt quite a lot about the condition since I’ve had it [laughs] and I’ve recognised that I was actually very lucky to get one of these tests. It’s, you breathe kind of into a machine, it’s just like, it’s very quick, it’s just about 20 minutes, you breathe into a machine, and the nurse takes three readings on that machine, and then she gives you some blue inhaler and you have to wait five minutes, and go back in, and see whether the blue inhaler has helped your breathing at all, see whether it brings your kind of baseline breathing up.

The reversibility test is then if you, you are discovered to have asthma, you’re put onto these quite large doses of what’s called a preventer inhaler [inhales] and you go back and for a lot of people then, they’re okay, and they can kind of manage either on a very small dose of preventer inhaler with a reliever inhaler, or with people in my condition, you have to stay on the preventer inhaler.

When I went to the hospital, the consultant said she wanted more tests and I said I’d just had the spirometry test, but she said they had kind of equipment to do even better and deeper diagnosis kind of thing [inhales]. So, it’s like a way really it’s a way that all everybody who has breathing problems should have the opportunity to have a spirometry test, but from what I understand, a lot of people don’t get that opportunity, they just are given a diagnosis kind of thing.

The diagnosis

The diagnosis of asthma is broadly based on a characteristic pattern of symptoms and signs and the absence of an alternative explanation. Most common are frequent and recurrent wheeze, cough, difficulty in breathing or chest tightness. They may often be worse at night and in the early morning, and they may be triggered by exercise or exposure to cold or damp air or allergens such as pollen or animal fur. Asthma is more likely if there is a family history (British Thoracic Society (BTS) Guidelines). Where there is a family history of asthma the symptoms may be recognised more quickly within the family.

The GP tested Melissa’s breathing after she fainted in PE. She was surprised to hear she had asthma, though her mum’s boyfriend had been suspecting it.

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Age at interview: 37

Sex: Female

Age at diagnosis: 16

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I didn’t actually pick up I had asthma. I was living at home with my Mum still. Obviously because I was only, I was about 15, 16. So I was living at home with my Mum. And it was my Mum’s boyfriend at the time kept saying to my Mum, “Oh I’m really worried, you really…” Because he had really bad asthma, really bad. And he kept saying I’m really worried about her, please take her to the doctors and get her checked out. And my Mum was sort of like, “Oh she’s okay, she’s okay.”

What sort of things was he worrying about? Actually how was it…?

Because I used to get out of breath very, very quickly, and the dust in the house used to make me very breathless and very, I just didn’t cope with the dust at all. If anyone disturbed it then I’d be coughing and unable to breathe and so it was quite hard, but I just used to, it was normal for me, because I couldn’t remember a time not being like it.

And then my Mum kept saying, “Oh no, she’s fine. It’s you know, she’s always been like it. And she’s fine.” And then I had a, I fainted. I was doing PE at school and fainted. And obviously had to go to the doctors for a check up for that. And...

I saw a registrar doctor, and he picked up on it a little bit that I was quite breathless and not right. And he said, “Oh I’d like to do a couple of tests.” And I sort of like went, “What do you mean?” I was a bit, you know, don’t like the sound of this. And he said to me, “Oh I think you might be asthmatic.” And I said, “Well, what’s that?” Because I hadn’t, even though I knew of it, because my Mum’s boyfriend had it, I didn’t really know a lot about it, so I was quite, oh my God, there’s something wrong with me!

So the doctor said, “Oh it’s just where your lungs are not working the way they should be. But if it is, we can get it sorted. It’s not a problem.” So I was sort of like, “Oh okay then.”

So he did a couple of tests. He made me go up and down the stairs in the doctors surgery and I was like really embarrassed because there was all these people in the surgery and I’m having to go up and down the stairs and I was, “ooh, ooh, ooh.” But I couldn’t breathe. I just got so out of breath, and really tight chested, and he said, “No, you’re definitely asthmatic. We need to get you on some inhalers and see if we can get this better for you.”

So I got the prescription for the inhalers. Went home and sort of like went, “Mum.” And she went, “Oh.” And she was quite shocked and her boyfriend was like, “I’ve been telling you for how long? And if you’d have listened this would have been sorted out a long time ago.”

But the doctor had said to me then, that he felt with how bad I was it had been going on for quite some, some years, and I sort of like said, “Well funny you should say that, because I’ve been getting very out of breath whenever my Mum dusts.” And he went, “Hm, yes, that’s all part and parcel of it."

Ann eventually suggested to her GP that as she had a family history of asthma, it might be worth trying asthma medication

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Age at interview: 55

Sex: Female

Age at diagnosis: 53

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And I think that in fact she did start me on some asthma medication before I saw the consultant. But, it, she wanted to start me on low doses, so but she didn't do that spontaneously as it were. It wasn't, I had to ask, I had to go back several times with my condition deteriorating.

And of course at that point she didn't know me very well so, it may be that I hadn't given her the information that she needed about my family history. But one day I was in such, I had such a lot of chest pain and I just couldn't breathe that I just made myself an emergency appointment and said to her, “Look I think it's asthma, I've got this family history, of very severe asthma in several family members I'm in such pain, would you not think it appropriate to try and prescribe me some asthma medication and let's just see if that improves my condition.” So in a sense I diagnosed myself, but she did agree to that and that's when I started on some fairly low doses of Ventolin plus a Beclazone inhaler and that did help me.

In some cases a confident diagnosis could be made at once, but as Val explains, testing if someone responds to treatment is often part of the diagnostic process. If an inhaler relieves or prevents symptoms, the diagnosis can usually be confirmed but it may still take a while to find the best dose and type of medication for the individual.

Julie was initially given salbutamol tablets to take but they didn’t help. A different doctor tried her on steroid tablets which were very effective but Julie didn’t realise her symptoms could come back.

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Age at interview: 68

Sex: Female

Age at diagnosis: 40

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We were living then in [Place name], in [Place name] and the GP was an ex-RAF chap and he was one of these sort of no-nonsense, you know, chaps and came and said, “Oh well, you know, you, you, you could have died. Why didn’t you come to me earlier?” And I thought, “Thank you very much. Actually I’m quite frightened enough, I don’t need you to say things like that”. And, anyway, he gave me some, what are they called? Ventolin tablets, which made me feel very peculiar but had some effect but not a lot. And I took those for a few days and he, fortunately this doctor was going away because I got much better treatment [laughs] from his sort of locum that was standing in. And my husband took me down to the surgery in the evening at about six o’clock. I saw this lady and she was very puzzled because I’d been sitting in the garden, it was summertime, and I looked terribly healthy. I couldn’t breathe.

And she wasn’t an expert on respiratory things so she talked to somebody else and then she rang me up about eight o’clock that evening and she said, “Can I come and bring you something? I think I know what the problem is”. And I said, “Yes, of course”.

So she came with a steroid tablet or two and it took about 48 hours I was human again, quite extraordinary for me. I was, you know, here I had been bumping downstairs on my bottom people had been hanging my washing out for me and doing all sorts of things because I was just so incapacitated. When I went to the bathroom and I crawled because I, walking, I’d get too breathless before I got there. So the steroid was a real wonder thing. And that was of course before I knew what it might do to me later. But that’s for later in the story.

So I took the steroid pills and I can’t remember how long for. I think I took them probably for a fairly, not what we consider, or we consider it long now but I think then I, I took them at a fairly high level and came down gradually. But over quite a long period.

And after that I didn’t really expect it to come back, which was foolish of course. I thought, “Oh, I’m better. Nice”. You know.

Stephen has recently been given inhalers to try, and he will return to see the GP in a few weeks. If they have helped the symptoms the doctor can be surer of the diagnosis.

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Age at interview: 25

Sex: Male

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I was out doing a bit of running in the evenings and after about three or four months my fitness wasn’t improving and I was still very out of breath and so I went to a doctor and, as a result, he diagnosed me with the early stages of asthma. The typical tell tale signs were, as I say, short of breath in the afternoons, even in the evenings where I wasn’t exercising and so that was my main concern. I wasn’t doing anything and was finding myself out of breath from just sitting down after a day’s work and that was worrying me because I’m still only twenty five. So...

Okay and when you went to the doctor, what actually happened?

I just went in and told him my concerns. I done a simple, few simple breath tests. He checked my lungs with a stethoscope.

And he gave me a prescription for two inhalers to take over the course of the next four weeks and then I have to check in with him, actually, next week to up-date my progress and if he’s happy that it is asthma I do have we’ll take the next step and if not, we’ll might have to be referred onto somebody else. But so far, I’m happy. I think the inhalers have made a slight improvement.

Charles saw his GP about a chest infection and recurring wheeziness and was diagnosed with asthma. He was given salbutamol (Ventolin) to inhale, which improved the symptoms. [Text only]

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Charles saw his GP about a chest infection and recurring wheeziness and was diagnosed with asthma. He was given salbutamol (Ventolin) to inhale, which improved the symptoms. [Text only]

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Age at interview: 71

Sex: Male

Age at diagnosis: 40

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In about 1980 I was suffering from wheezing, wheezing problems and they were probably brought on more by colds and just occurring sort of naturally without anything to prompt them. And I think I went to a doctor for treatment for some chest complaint and he did a volume analysis of my lung as a part of a routine inspection and diagnosed that I’d got asthma, or he felt I’d got asthma. And he suggested that I should initially take some Ventolin as it was then termed and see how it went, and if that worked then to put me on a more permanent treatment.

And I did it, and it did work and it removed the discomfort I had. The, what we were talking about as asthma, it wasn’t to me apparent as asthma at the time, because it didn’t stop me or inhibit me from doing anything. And, I was more a discomfort, especially at night when you’re sleeping or lying down. And rather than being a painful experience at any stage.

GPs may recognise asthma symptoms, or they may look at other explanations first. As other conditions such as anxiety, infections and even heart problems can cause breathlessness, the GP may explore these first. People may be given an inhaler to try out immediately, or they may be given an antibiotic or other medication to try before inhalers are suggested. Sometimes where symptoms are severe and persistent the doctor may prescribe steroid tablets and/ or antibiotics to improve things quickly, before moving to try inhalers, or a combination of both types of treatment. Peter (below) went to the doctor because of a chest infection:

Peter was initially treated for a chest infection but after taking antibiotics which didn’t clear things up doctors realised he had probably developed asthma too.

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Age at interview: 62

Sex: Male

Age at diagnosis: 45

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I was diagnosed with asthma when I was 45. I am now 62 so that’s a little while ago. It’s called late onset asthma so not as child. The circumstances were I think not uncommon. I developed a nasty cough and cold which didn’t go away and didn’t go away and didn’t go away and eventually I went to the doctor and he said, “Ah I think you’ve got a chest infection and gave me some antibiotics, which weren’t effective.

I went back two weeks later. A different antibiotic and that didn’t work either. And he said, finally he’d getting some analysis of the stuff I was coughing up. When the result of that came back then there was a very specific condition diagnosed as being called pseudonumo something or other and a very specific antibiotic was then prescribed and, and that did improve matters a lot, but I still wasn’t completely so I went back to the doctor and he said, “You know, I think you might have asthma.” And that’s how it turned out.

I mean the first time I went to the doctor with this chest complaint, I’d had it perhaps for two months before I went because we all get these things from time to time, and you think it’ll clear up. It didn’t and I was, you know, getting run down and you know, feeling quite, quite ill. So I went to see him and it then probably took another couple of months to go through the whole process of no that didn’t work, no that didn’t work, ah now we’ve cured the infection but I’m still not quite right, ah you think you’ve got asthma. Yes that was probably about a 4 month time period. Something like that.

For some people, like Margaret, a sudden onset of severe symptoms led to a diagnosis.

Margaret had a persistent cough and was diagnosed with pneumonia. Her symptoms became so bad one night that she went to the hospital for emergency treatment and was told that it looked like she also had asthma.

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Age at interview: 62

Sex: Female

Age at diagnosis: 47

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I was actually diagnosed with asthma round about my 47th birthday and it was not the best birthday present for me. I’d had a persistent cough through the summer - I’m a summer baby, and it got so bad that I presented at the local hospital in the middle of the night because I felt as if I couldn’t breathe and I was diagnosed with, with pneumonia. And then after that they said, “No, it wasn’t just pneumonia. It was all mixed up with asthma.”

So I left hospital with a plethora of, to me it seemed a plethora of drugs. An information book, produced by GlaxoSmithKline and really, I just got on with it. And probably looking back I didn’t actually manage things terribly well, because there is, when you first are diagnosed, especially the sort of age that I was diagnosed at, there was just that feeling of, well, just why me? You know, I’ve led a healthy life, I’ve never smoked, not even so much as a puff behind the bike shed. And suddenly this, sort of presented itself to me as a 47th birthday present. And it’s not one of the best ones I’ve had.

So I didn’t really manage it terribly well to begin with.

Margaret had had less severe symptoms for a while beforehand, but in others like Mark who had childhood onset a sudden and frightening severe attack may be the first sign of asthma.

Asthma can be difficult to diagnose, particularly because it may not be clear whether the symptoms are caused by asthma or something else, and they often vary over time. It can improve greatly, and it can also get worse, sometimes for no obvious reason. Some people had found it hard to get a diagnosis initially. A few felt doctors were slow to realise the cause of their symptoms.

When she was first diagnosed Jenny’s consultant focused on treating her allergies – ‘he wasn’t as interested in the other things that triggered it like the colds and the viruses and the stress.’

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Age at interview: 34

Sex: Female

Age at diagnosis: 18

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I went to the doctor and they did the, they do your peak flow when you blow in and he looked, you know, he listened to my chest. He said, “Well. There was no wheeze there now”, but you know he did the peak flow and he put, he put me on a twice a day inhaler and then gave me the blue, a blue one and said, you know, “Use this if you get short of breath”, and all, you know, the usual gumph. And then over the next few years I sort of, in the hay fever season I’d be worse but I didn’t sort of think anything of it. If I got a cold I would, you know, I’d have a, I’d have a week on steroids. They give you some oral steroids to take for five days and then, you know, you’d be fine again. And then I got to the point where I was having oral steroids more often.

So it was building up over time?

Yeah, it was, it was gradually getting worse. So my GP said, you know, “I’ll refer you up to the hospital because I think we need to, to look into this further”. So, he actually referred me to an allergy specialist because there was so much of it was allergy related, which in hindsight, probably wasn’t the best because, I mean he was, he was a great, a great doctor, slightly arrogant, but, you know, who was so focused on my allergies and minimising my allergy exposure and yeah, and sort of cleaning my life up so I wasn’t exposed, didn’t, he didn’t actually look at me and how I was living and he didn’t actually look at my asthma which I know sounds really odd, but he was, his theory was if he could limit my allergy exposure then the asthma would sort itself out. But because he wasn’t a chest physician, he was an allergy consultant, he wasn’t as interested in the other things that triggered it like the colds and the viruses and the stress and things.

Ann describes how the doctors explored other possible causes for her breathing difficulties when she first went to the hospital.

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Age at interview: 55

Sex: Female

Age at diagnosis: 53

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And I was working about 25 miles away from home, and I used to... come out of work in the evening, get into my car, turn the radio on, find a pop station, and I’d be singing along to the music all the way home. But on this one particular day I found that I just couldn’t sing, and I was very, very short of breath, and it was a very new experience for me, that hadn’t really happened to me before, so I thought to myself, ok.... I don’t like this very much but let’s just see what happens in the morning. And because my husband works away from home most of the time on that particular day and evening I was at home by myself, but on that particular day I was preparing for the move.

But the following morning when I woke up in the morning to go to work I was really short of breath and I was really scared. I’d never had that experience before, so I rang my work and said I wouldn’t be coming in, I rang my GP surgery and made an appointment, and I had a good relationship with my GP, and he’d been treating me for about 10 years so he knew me quite well and when I actually walked in to his surgery he could see immediately that I was having very severe breathing problems. He started to panic, and of course that made me very worried. I’m not sure ‘panic’ is quite the right word, but he took it extremely seriously, and he immediately rang for an ambulance to take me to the local district general hospital, and before very long the ambulance turned up. At that point I couldn’t talk, I was given oxygen, put in the ambulance, I was taken off to the hospital and taken immediately onto a ward rather than just A&E, and at that point things just stopped really. I was put on a bed and my blood pressure was taken, a junior doctor came to talk to me, got some basic information about me and what had happened in the last 24 hours. She explained that I was going to have a chest x ray because my GP was concerned that I might have a blood clot on the lung and although it wasn’t very likely it was very sensible to have that checked out. So there I was, I was put on the bed and I was left alone for quite a long time. I was very anxious and very worried about what was happening. My husband was quite a long way away and there was no point in trying to get in touch with him at that stage um, so after some time I was wheeled off and I had my chest x ray. And actually I don’t remember very much about that ...it’s all a bit of a blur.

But I had my chest x-ray. I was brought back to the ward, put back on the bed. And then I just lay there for about an hour, again sort of left to my own devices. I had actually brought a book with me because I knew that sometimes when I went to see my GP I'd have to wait awhile if he was running late. So I, I read a bit. And gradually as I lay there my breathing began to normalize, but I didn't really have much of a clue what was going on. My first reaction was that I think I've probably got a bad, having a bad asthma attack. Only because there's a lot of asthma in my family so although, I've never had this experience before. I was, I was half my mind was on my book and half my mind was thinking about, to try and understand what was happening to me, and that seemed to me the most likely explanation.

So after about an hour or so, I was told that I could get up, get dressed and go and sit in a waiting room, which was adjacent to the ward so that's what I did. It was very crowded, very hot for the people in there, kind of waiting. After about another forty-five minutes I was called out by a junior doctor, a different doctor to the person who'd spoken to me previously. It was a young man. So basically, he just called me out onto the corridor we stood there by the nurses’ station and he said that, “Well I've, I’ve looked at your chest x-ray, it looks absolutely fine, you don't have a blood clot but your heart is enlarged and that could be the cause of your breathing problems so you can go home now but you need to go back to your GP and ask them to refer you to us again for an investigation of your heart.” And I was just absolutely dumb struck. And I think of myself as quite an articulate person but the way that he just gave me this information, standing there in the corridor with loads of people all around. I was really shocked because I'd always believed that I had a, a healthy heart from everything, I’ve known previously.

(Also see ‘Relationships, family and friends’ and ‘Early signs and symptoms’).

Last reviewed August 2017.