Clinical assessment of asthma

Diagnosing asthma

A clinical diagnosis of asthma is often prompted by symptoms such as breathlessness, cough and chest tightness. An accurate diagnosis of asthma requires an assessment of clinical symptoms, measurement of airway function and response to therapy, and occasionally, the use of provocation tests. 

Classifying asthma

Asthma was previously classified according to its severity. However, asthma severity can be highly variable and may also depend on responsiveness to treatment.

For this reason, GINA now promotes a classification system based on asthma control rather than severity (Table 1).1

13 fig 1GINA asthma control
Table 1: Levels of asthma control according to GINA1
Reproduced with permission from the Global Strategy for Asthma Management and Prevention 2012, © GlobalInitiative for Asthma (GINA) all rights reserved.     

Lung function tests such as spirometry are routinely performed in the clinic to measure changes in pulmonary function, and these include:1
  • Forced expiratory volume in 1 second (FEV1) measurement.
  • Forced vital capacity (FVC) measurement.
  • Peak expiratory flow (PEF) measurement.
Predicted values of FEV1, FVC and PEF based on age, sex and height have been obtained from population studies and are, with the exception of PEF (for which there is wide variability), useful for judging whether lung function is abnormal. Hand-held PEF-meters are, however, used by patients to obtain objective daily measurements of airflow limitation.1

Several standardized and validated measures for assessing other components of clinical asthma control (such as symptoms and limitation of activity) are also available. These include the Asthma Control Test™ (ACT) and Asthma Control Questionnaire.1

When asthma control has been achieved, ongoing monitoring of the level of control (daytime/nocturnal symptoms, limitation of activities, lung function and need for reliever treatment), typically every 3 months, is essential to:
  • Maintain clinical control
  • Establish the lowest step and dose of treatment necessary
  • Maximize the safety of treatment
  • Minimize costs

  1. The Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention. Available from: 2012
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