How Asthma Is Diagnosed

Asthma is diagnosed based on your symptoms, a physical exam, and various tests, including lung function tests to evaluate breathing. Because the telltale symptoms of asthma are common in other respiratory conditions, differential diagnosis also may be necessary to rule out causes other than asthma.

Female doctor assists young asthmatic patient
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This article will discuss the various types of tests that may be part of a diagnostic workup for asthma.

Self Checks / At-Home Testing

Asthma is not a disease that can be self-diagnosed. But becoming familiar with the most common symptoms can alert you to the possibility you or your loved one might have asthma, in particular:

If you develop these symptoms and they become persistent, make an appointment to see your healthcare provider or a pulmonologist (a physician who specializes in respiratory diseases).

Try to keep a record of your symptoms, including when and where they occur. This may help reveal a pattern of asthma flare-ups that can help pin down your diagnosis and potential asthma triggers.

Physical Examination

To diagnose asthma, your healthcare provider will start by asking about your medical history and ongoing health issues. Asthma is especially common in people who have atopic conditions such as hay fever (allergic rhinitis) or atopic dermatitis.

Your family health history will be important as well, as asthma tends to run in families.

They will want as many details about your symptoms as you can provide. This is why keeping a record of your symptoms is invaluable. Also, share with the healthcare provider any changes you've made in your daily life that might have been prompted by asthma symptoms.

The next step in diagnosing asthma will likely be a physical exam that focuses on your breathing. The healthcare provider will listen carefully for wheezing, which isn't present all the time in people with asthma, but if it happens to occur during your appointment it will provide a strong clue as to your diagnosis.

Lung Function Tests

If your healthcare provider finds signs of asthma, they will likely run a lung function test to get more information about the type and severity of your condition.

Spirometry

Spirometry is the most common lung function test. To do this test, you put a mouthpiece in your mouth and a clip on your nose. You then breathe into a tube connected to a small device called a spirometer.

This device measures two things:

If your results show reduced lung function, your technician may give you a medicine called a bronchodilator to open your airways. You'll then take the test again to see if your lung function improves. If the medication brings about an increase in airflow of 12%, it is an indication that asthma is the cause of symptoms.

Spirometry is the main test for detecting and measuring airway obstruction associated with asthma.

Peak Expiratory Flow Meter Test

Peak expiratory flow rate (PEFR) is a measurement of how powerfully you can blow air out of your lungs. This is measured with a simple hand-held device called a peak flow meter. A normal PEFR is 80% or greater than what would be predicted for the person being tested.

Fractional Exhaled Nitric Oxide (FeNO) Test

If after routine testing, an asthma diagnosis isn't certain, a fractional exhaled nitric oxide test may be performed. This test is often simply referred to as a FeNO test.

A FeNO test uses a handheld device to measure the amount of nitric oxide you exhale. Having a high level of nitric oxide in your exhaled breath often means your airways are inflamed (swollen).

Requirements for Asthma Diagnosis

An asthma diagnosis requires:

  1. Presence of symptoms compatible with asthma such as cough, wheezing, or shortness of breath.
  2. Objective measurement of decreased airflow in your lungs that either partially or completely improves spontaneously or with treatment.

Provocation Tests

If your doctor wants to see how sensitive your lungs are, they may have you do a provocation test. These tests are also called bronchoprovocation challenges or tests.

You'll take a breathing test (spirometry) before and after each challenge. This allows your healthcare provider to see if your lung function changes and if so, by how much. The most common provocation tests are:

  • Exercise challenges: During an exercise challenge, you'll be asked to walk or jog on a treadmill. A technician will measure your lung function during an exercise test before, during, and after exercise. If your breathing ability decreases by 10% or more after exercising, you likely have exercise-induced bronchoconstriction (EIB).
  • Irritant challenges: During an irritant test, a technician exposes you to an asthma trigger to see if your airways react. Potential triggers include perfume or smoke.
  • Methacholine challenge: During this test, you'll breathe in increasing doses of an inhaled drug called methacholine. If your lung function drops by 20% or more from the baseline, you may have asthma. This test is used when suspicion is high, but spirometry is ambiguous or normal.

If your airways tighten during any of these tests, you'll be given a fast-acting bronchodilator to re-open them. 

Imaging Tests

Most people with asthma have normal chest X-rays, but some healthcare providers order them for patients who are experiencing wheezing for the first time. This is because if asthma has gone undiagnosed for a long time, a chest X-ray may reveal hyperinflation (overinflated lungs).

Differential Diagnoses

Because wheezing can be symptomatic of diseases other than asthma, your healthcare provider may need to rule them out to definitively diagnose asthma:

  • Gastroesophageal reflux disease (GERD): GERD may lead to wheezing and cough; it's also commonly responsible for nighttime symptoms. Patients commonly experience a painful burning sensation as well as a sour or bitter taste in the back of the mouth.
  • Congestive heart failure: This is a condition where the heart's pump is failing and unable to provide adequate blood supply. In addition to asthma-like symptoms, there may be swelling in both legs and difficulty breathing while lying down.
  • Chronic obstructive pulmonary disease (COPD): A significant difference between COPD and asthma is that COPD often is characterized by a morning cough, while asthma symptoms can occur at any time and often only after exposure to triggers.
  • Pulmonary embolism (PE): The sudden onset of shortness of breath and chest pain is the most common symptom of PE, but the condition sometimes causes wheezing that could initially be mistaken for asthma.
  • Cystic fibrosis (CF): CF patients will wheeze, as well as experience shortness of breath and cough. However, this chronic illness is also associated with poor growth and several other problems in early childhood.

Summary

If you have persistent symptoms of wheezing, coughing, shortness of breath, and chest tightness, you should see a healthcare provider to get checked out. They will likely take your medical history, do a physical exam, and give you a series of breathing tests to see how well air can move in and out of your lungs. This is usually enough to diagnose asthma, but in some cases, imaging tests such as an X-ray might be done as well.

A Word From Verywell

Because asthma is a progressive disease—one that can worsen without treatment—it's imperative to see a healthcare provider as soon as symptoms arise. An early diagnosis is key to effective treatment and preventing the disease from interfering with your quality of life.

Frequently Asked Questions

  • When are children most commonly diagnosed with asthma?

    About 80% of asthma develops before the age of 6. By the time children with asthma reach their teen years, however, remission is common.

  • Can asthma develop in adulthood?

    Yes. In fact, as many as half of adults with asthma develop it after childhood. Risk increases with age, and, unlike childhood asthma, remission is rare.

  • What is the What is the difference between asthma and exercise-induced bronchoconstriction?

    In exercise-induced bronchoconstriction (EIB), people experience airway constriction only when they exercise. In contrast, asthma is a chronic condition.

    An allergist can help you determine whether the symptoms you experience during physical activity are related to allergies (such as pollen or grass), irritants in the air (such as pollution), EIB, or underlying asthma.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Horak F, Doberer D, Eber E, et al. Diagnosis and management of asthma - Statement on the 2015 GINA GuidelinesWien Klin Wochenschr. 2016;128(15-16):541–554. doi:10.1007/s00508-016-1019-4


  2. Langan RC, Goodbred AJ. Office spirometry: indications and interpretation. Am Fam Physician. 2020;101(6):362-368.

  3. Nasreen S, Nessa A, Islam F, et al. Changes of peak expiratory flow rate in adult asthmatic patient. Mymensingh Med J. 2018;27(2):245-250.

  4. Cloutier MM, Baptist AP, Blake KV, et al. 2020 focused updates to the asthma management guidelines: A report from the National Asthma Education and Prevention Program Coordinating Committee expert panel working group. Journal of Allergy and Clinical Immunology. 2020;146(6):1217-1270. doi:10.1016/j.jaci.2020.10.003

  5. Johnson J, Abraham T, Sandhu M, Jhaveri D, Hostoffer R, Sher T. Differential Diagnosis of Asthma. In: (Editor-in-Chief) MM, ed. Allergy and Asthma: The Basics to Best Practices. Springer, Cham; 2019:383-400. doi:10.1007/978-3-030-05147-1_17

  6. Hait EJ, McDonald DR. Impact of gastroesophageal reflux disease on mucosal immunity and atopic disordersClin Rev Allergy Immunol. 2019;57(2):213-225. doi:10.1007/s12016-018-8701-4

  7. Ren CL, Konstan MW, Rosenfeld M, et al. Early childhood wheezing is associated with lower lung function in cystic fibrosisPediatr Pulmonol. 2014;49(8):745–750. doi:10.1002/ppul.22894


  8. Trivedi M, Denton E. Asthma in children and adults-what are the differences and what can they tell us about asthma? Front Pediatr. 2019;7:256. doi:10.3389/fped.2019.00256

Additional Reading

By Pat Bass, MD
Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians.