“Diagnosis of asthma requires a high degree of clinical suspicion”

“Diagnosis of asthma requires a high degree of clinical suspicion”

“Bronchial asthma and allergies” was the topic of World Allergy Week 2022, which took place this month, between June 11 and 15. As explained by Pedro Morais Silva, immunoallergologist and stakeholder group (GI) coordinator at the CSP of the Portuguese Society of Allergology and Clinical Immunology (SPAIC), these are two different clinical entities that, however, often intersect.

“It is important to be aware of both in order to choose the most appropriate treatment. About 90% of children and 50% of adults with asthma are allergic.

Because he is in constant contact with primary care, Pedro Morais Silva emphasizes the “basic” role of the family doctor in the diagnosis, treatment and prevention of asthma. And he warns of the need to pay attention to certain key symptoms in different age groups.

“Some patients see asthma as a limiting disease, which manifests itself only occasionally, so they think they do not need daily medication. They devalue more frequent mild manifestations, such as wheezing or cough associated with exercise, ”he comments.

In other words, they usually do not complain, which means betting on an “active diagnosis”, ie the clinician must be the one who asks questions, as with other pathologies, ie hypertension and diabetes. Asthma requires a high degree of clinical suspicion. ”


Pedro Morais Silva

Special attention should be paid to groups at higher risk, such as smokers, users who are overweight or obese, and those who suffer from allergic rhinitis. “In the spring, it is common to have more situations of rhinitis, which are essentially manifested by nasal congestion, runny nose, sneezing and nasopharyngeal itching. And you have to ask if a person has a persistent dry cough, chest tightness, shortness of breath, wheezing or limited effort, even sporadically, ”says Pedro Morais Silva.

In this way, he says, it is possible to combat the “insufficient diagnosis and non-treatment” of entities that have very negative consequences for a person’s quality of life.

CARAT: “easy and fast” tool

Therefore, in order to properly control the disease, Pedro Morais Silva advocates the use of validated questionnaires, such as CARAT, which is available even on the Internet and allows early detection of possible cases of asthma. “It is an important help because, unlike other pathologies, there are no easily available complementary diagnostic tests,” he emphasizes.

In addition, it is “a practical, fast and proven tool for the Portuguese language, both for children and adults”. This should, for example, be “a bet in the case of patients with rhinitis who have bronchial symptoms, not only for diagnosis, but also to measure the development of the situation.”

This “search for a diagnosis” is also important because, as he says, “tests are not always exhaustive”, because asthma, as a rule, manifests itself in the interim. “Even bronchial obstruction is dynamic, worsening depending on the environment, season or contact with allergens,” recalls Pedro Morais Silva.

The immunoallergist also warns of the need for constant monitoring and monitoring of the disease and the importance of demonstrating the use of the drug:

“Proper use of inhalers is necessary, because their improper use is enough to make the situation worse. In addition, not all of these devices are the same, which can be very confusing. ”

And remember that SPAIC organizes training actions on this topic, both for health professionals and the general public. The need to sensitize the patient to the fact that it is a chronic pathology that even without symptoms implies the existence of inflammation is also emphasized. “You must not lower your guard! “Its natural history, in some cases, is characterized by progressive deterioration over time,” he said.

What also makes all the difference in asthma control is the simultaneous treatment of allergic disease: “For example, allergic rhinitis affects about one in four Portuguese and can worsen asthma when simple activities such as walking or playing with children in the garden in the spring.”

But Pedro Morais Silva warns that “family doctors should also be aware of allergic reactions caused by mites, food, drugs and hymenoptera, not just those caused by pollen in the spring.”

Regarding the referral to immunoallergology, the doctor believes that resistant cases should be referred to the first phases of treatment and the most severe ones, which potentially require therapies that are applied in a hospital environment.

“Regardless of specialist consultations, asthma should always be monitored together in PHC, which is why SPAIC invests so much in training in this area,” said our interlocutor, guaranteeing that “family doctors are increasingly able to deal with asthma and allergic diseases.”

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