Assessment Overview

• May be useful in certain clinical environments and are useful for screening, documentation and recording of symptoms for audit or follow-up. For more information see Questionnaires

• Assess FBC (including peripheral blood eosinophils), total IgE, serum-specific IgE
• Elevated eosinophil count , IgE and FeNO suggest the presence of Type-2 inflammation
• Specific IgE to common allergens (house dust mite, pollens, moulds, animals) indicate atopy and Type-2 inflammation
• Allergy assessment tools include questionnaires, skin prick testing, specific antibody testing, rhinoscopy, challenge testing (inhaled and ingested) and upper airway CT imaging

• Provides evidence of Type-2 inflammation in the airways. For more information see Phenotyping – FeNO

• Aspergillus specific IgE indicates sensitisation to aspergillus fumigatus
• Additional diagnostic tests indicate possible allergic bronchopulmonary aspergillosis (ABPA) , such as elevated serum IgE >1000 IU/mL, elevated aspergillus specific IgG, Positive Aspergillus precipitins, blood eosinophilia.

• Positivity may be consistent with Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome)

• HRCT is done to rule out or identify coexistent disease (e.g. bronchiectasis, mucous plugging, parenchymal infiltrates, fibrosis, cystic lung disease, emphysema). For more information see Imaging

• Microbiology may be useful when there is persistent mucous hypersecretion and co-existent bronchiectasis.
• Inflammatory cell assessment may be useful to determine inflammatory phenotype in certain clinical situations. However, it is only available in specialised research units. For more information see Phenotyping – Sputum Assessment

• Selecting appropriate severe asthma patients for invasive biopsy has been recently reviewed (Doberer et al. 2015)
• There are no guidelines on the use of invasive biopsy in the workup of severe asthma and this remains an individual decision. For more information see Bronchoscopy

• For a detailed overview see: Comorbidities – Vocal Cord Dysfunction
• Asthma assessments include: Formal vocal cord assessment ±challenge, dynamic upper airway CT Scan (Low et al. 2011)
• Forced Oscillation Technique (Ioan et al. 2016) and questionnaires (e.g. LHQ, PVCDI)
• Useful Reference: Official Joint ERS / ELS Statement on Inducible Laryngeal Obstruction (Halvorsen et al. 2017)

• Electrocardiogram
• Echocardiogram
• Cardiac risk assessment tool

• For a detailed overview see: Comorbidities – Anxiety & Depression
• Assessments include: formal psychological assessment and questionnaires (e.g. HADS)
• Mood disorders may either cause asthma-like symptoms or worsen the symptoms of asthma.
• Objective tests may help determine the relative contributions of fixed and intermittent airway narrowing, and mood disorders to symptomatology.

• For a detailed overview see: Comorbidities – Obesity
• Obesity adds an additional elastic load to breathing and hence may cause asthma-like symptoms, including wheeze, particularly during exertion
• May accentuate asthma symptoms, and make them less drug-treatment responsive

• For a detailed overview see: Comorbidities – GORD
• GORD may trigger airway narrowing, thereby worsening asthma symptoms.
• Assessments include: Formal gastroenterological assessment and GERD-Q questionnaire

• Bronchitis is a common cause of asthma-like symptoms and may co-exist with asthma
• Separating the mucous hypersecretory component from the asthmatic component may be difficult or impossible
  • Subjectively via symptoms assessment
  • Objectively via peak flow variability
• Cough variant asthma was first described by (Corrao et al. 1979)
  • In 6 cases – cough alone was present with normal spirometry, AHR to methacholine, reduced sGaw, increase phase III of the nitrogen washout.
  • This study reported a complete and prompt response to bronchodilator treatment.
  • Subsequent reports highlighted the presence of eosinophilic inflammation in cough variant asthma.

• For a detailed overview see: Comorbidities – Obstructive Sleep Apnoea
• Obstructive sleep apnoea (OSA) is common in asthma & treatment of OSA may benefit asthma

• For a detailed overview see: Comorbidities – Dysfunctional Breathing
• This may mimic asthma symptoms, and often coexist with asthma. It therefore may worsen symptoms and lead to apparent severe asthma due to lack of response to asthma treatment.
• Assessments include: History, questionnaire (e.g. Nijmegen), and investigations where appropriate e.g. arterial blood gas (ABG) analysis and tidal breathing monitoring (Boulding et al. 2016).

• Intolerance to common food components may worsen asthma symptoms and contribute to treatment resistance.
• Common chemicals responsible for intolerance in asthma are salicylates (aspirin intolerance), sulphites, amines, monosodium glutamate (MSG).
• A good dietary history, food diary and assessment by a dietitian with appropriate expertise and allergy clinic review. ASCIA provides a useful resource for reference here

• Occupational exposures may contribute to symptom burden
• Further information is available at:
  • (Malo et al. 2011).
  • Australian Asthma Handbook.
  • The Official American Thoracic Society Statement: Work-Related Asthma (Henneberger et al. 2011)

Recent publication on occupational lung diseases in Australia (Hoy et al. 2017)