Mild asthma.(Women's Health Adviser)

Asthma is often undiagnosed or incorrectly diagnosed, experts say, and this is especially problematic among women of reproductive age. While pregnant women with moderate to severe asthma face at least a doubling in the risk of intrauterine growth restriction, the risk for those with undiagnosed asthma is even greater, probably due to fetal hypoxia.

The importance of diagnosing asthma early and controlling it effectively has experts divided on who should manage the illness, even in patients with mild disease. While diagnostic criteria call for spirometry testing before and after a short-acting bronchodilator, the ob.gyn. is unlikely to keep this specialized equipment on hand. Conversely, this method can't always confirm mild intermittent asthma because the patient's airways are often open and don't show reversibility with bronchodilation. However, in most cases, pulmonary function tests will be necessary to determine the diagnosis.

The National Heart, Lung, and Blood Institute's Guidelines for the Diagnosis and Management of Asthma recommend specialist referral if there is any question about the differential diagnosis, if there are complicating respiratory conditions, or if the patient requires additional education, needs intensive medical therapy, or is not meeting therapeutic goals.

Diagnosis

Primary care physicians who manage patients with mild asthma may wish to refer them for diagnostic lung function tests. Findings that increase the probability of asthma include hyperexpansion of the thorax, chest tightness, sputum production, and wheezing during normal breathing, or a prolonged phase of forced exhalation. The absence of wheezing during forced exhalation is not a reliable marker, because wheezing may be absent in mild or even moderate asthma. Since up to 70% of asthma patients also have allergies, allergic manifestations such as increased nasal secretions, mucosal swelling, atopic dermatitis, and eczema may be present.

The patient may complain of periodic symptom occurrence. Asthma tends to be worse at night, and symptoms may awaken the patient. Symptoms also may occur during exercise, especially in cold weather, or in a seasonal pattern with changes in weather or pollen. Symptoms may worsen during menses.

Patients with mild intermittent asthma experience symptoms twice a week or less; between exacerbations they are asymptomatic and have normal lung ...