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Asthma : Diagnosis
   
Western Medicine Chinese Medicine

The diagnosis depends on three things:

1. Symptoms of airflow obstruction.
2. Airflow obstruction must be at least partially reversible.
3. Alternative diagnoses such as sinusitis, hay fever, foreign body in the windpipe or lungs, lung infection, heart disease or other conditions that cause wheezing have been ruled out.

Western doctors diagnose asthma from a history of episodes of wheezing, family history and history of allergies. The physical exam reveals wheezing, an expanded chest wall, use of extra muscles to assist breathing and evidence of allergies such as eczema or atopic dermatitis. (Note: Wheezing may not always be heard on a physical exam but this does not rule out a diagnosis of asthma.) Tests used to confirm or rule out asthma include lung function tests that measure the amount of air exhaled and peak expiratory flow testing, which can be measured at home. This test also measures the amount of air exhaled. Other tests that may be performed include chest x-rays, allergy testing, blood work or other tests that evaluate nasal polyps and sinus disease.

TYPES OF ASTHMA
The classification of asthma varies from country to country, even among western doctors but in the US it is divided into four types. These are:
1. Mild intermittent asthma where symptoms occur two times or less per week, the person is normally healthy between asthma episodes, each episode is quite brief and night symptoms occur two times or less per month.
2. Mild persistent asthma where symptoms occur more than two times per week but less than once per day, night symptoms occur more than two times per month and the asthma episodes may interfere with daily activities.
3. Moderate persistent asthma where symptoms occur daily, a bronchodilator medication is needed to relieve symptoms every day, asthma episodes interfere with daily activities, asthma episodes occur more than two or more times per day and may last for days and night symptoms occur more than once a week.
4. Severe persistent asthma where continual symptoms are present, the person has limited physical activity because of his asthma symptoms and night symptoms are frequent
 

Using the four examination techniques of looking, listening and asking questions, smelling and touching, TCM practitioners analyze asthma symptoms and diagnose individuals according to the different TCM classification patterns.

Differentiation between wheezing and panting
Wheezing is characterized by a whistling sound, while panting is when individuals have difficulty breathing. Both of them can be manifestations of asthma and related to acute or chronic disease.

Differentiation between chronic cough and asthma
Asthma or wheezing/panting syndrome is associated with episodes of remission and serious exacerbations, whereas a chronic cough is persistent and does not go away. They can be further differentiated by the characteristics of the cough. With a chronic cough, the coughing sound is usually stronger than the wheezing sound. With asthma, the reverse is true. In general, the wheezing sound is stronger.

Differential classification of disharmony patterns
Asthma belongs to a disharmony pattern featuring both excessive pernicious evils and deficient normal qi. Mainly an excess of pernicious evils, (environmental factors that cause illness) causes exacerbations of asthma. This type of asthma is associated with coarse breathing and a high-pitched wheezing sound. Each breath is long and deep with a rapid expiration time. The pulse is strong, and generally, the body is not in a weak state.

The non-exacerbation period is related to a deficiency of normal qi. Asthma due to deficient normal qi is associated with weak breathing and a low wheezing sound. The breath is short and not smooth. There is usually a long history of asthma, where the individual experiences difficulty with inspiration. This deficient-type of asthma is associated with a sinking and weak pulse or a thin and rapid pulse .

After differentiating between an excessive evil type and a deficient normal qi type, it is also necessary to distinguish the type of phlegm (hot or cold) and identify the disharmonious organs. Details of the corresponding symptoms are listed under the "Symptoms Section".

The major disharmony patterns of asthma are as follows:

Exacerbation:
1. Cold type asthma
2. Heat type asthma

Non-exacerbation:
1. Lung Deficiency
2. Spleen Deficiency
3. Kidney Deficiency