Imaging Studies

Chest radiography: Include chest radiography in the initial workup if the asthma does not respond to therapy as expected. In addition to typical findings of hyperinflation and increased bronchial markings, a chest radiograph may reveal evidence of parenchymal disease, atelectasis, pneumonia, congenital anomaly, or a foreign body. In a patient with an acute asthmatic episode that responds poorly to therapy, a chest radiograph helps in the diagnosis of complications such as pneumothorax or pneumomediastinum. Chest x-ray is not always necessary. It can document the increase of pulmonary volume, infiltrates areas due to atelectasis of distal obturated airway, this feature is important in suspecting of their infection.

Asthma. A. The typical X-ray data 9-year-old child.

 The inflation and increased lung pattern. B. 7-year-old child with a more pronounced changes. C. Side projection showing swelling with flattening of the diaphragm and increased anteroposterior diameter at the top.

(From Edwards D III: The child who wheezes. <IT+>In:<IT-> von Waldenburg Hilton S, Edwards DIII (eds): Practical Pediatric Radiology, 2nd ed. Philadelphia, WB Saunders, 1994, p 106.) 

Paranasal sinus radiography or CT scanning: Consider using these to rule out sinusitis.  

Optical coregent tomograph of new generation

                             Computor tomography. Emphysema.

               

a                           b                                 c               Chronic Sinusitis

Image 1a, b and c (Computed Tomography): There is mucosal thickening of the right maxillary sinus with no bony obstruction or soft tissue changes. Associated with this is mucosal thickening of the right ostiomeatal complex. The left maxillary antrum and ostiomeatal complex are unremarkable.

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Other Tests

Allergy testing: Allergy testing can be used to identify allergic factors that may significantly contribute to the asthma. Once identified, environmental factors (eg, dust mites, cockroaches, molds, animal dander) and outdoor factors (eg, pollen, grass, trees, molds) may be controlled or avoided to reduce asthmatic symptoms. Allergens for skin testing are selected on the basis of suspected or known allergens identified from a detailed environmental history. Antihistamines can suppress the skin test results and should be discontinued for an appropriate period (according to the duration of action) before allergy testing. Topical or systemic corticosteroids do not affect the skin reaction.

In the period of remission allergic skin tests are conducted, positive analysis of which gives the possibility to exclude contact with the causative allergen, that is the key of the recovery.

                                Allergic prick text. (Courtesy of MR Sly, M.D.)

The analysis of sputum: eosinophilia, Kurshman spiral (cylinders of the bronchioles), crystals Charcot - Leiden; neutrophilia proves the existence of bronchial infection.

A–eosinophyles

B– Charcot - Leiden crystals

C– Kurshman spiral                                                                         

Arterial blood gases: typical symptoms of hypoxemia during attacks and is usually expressed in hypocapnia and respiratory alkalosis, a normal or increased partial pressure pCO2 showes a significant fatigue of respiratory muscles and airway obstruction.

                      Differential diagnosis

"Any wheezing" - is not bronchial asthma. Differentiated with CNS diseases, chronic bronchitis and (or) emphysema, obstruction URT caused by foreign body, tumor, edema of the larynx, carcinoid tumors (usually followed by a crowing, but not wheezing), repeated emphysema, eosinophilic pneumonia, dysfunction of the vocal folds, systemic vasculitis with lesions of the lungs.

Clinically the most important is differential diagnosis with bronchiolitis and laryngotracheal stenosis due to similar clinical picture. 

Differential diagnostics

 attack of bronchial asthma that laryngotracheal stenosis

Criteria

Bronchial asthma

Laryngotracheal stenosis

Background of process 

Period of precursors

ARVI (parainfluenza)

Cough

Dry, with transition in moist one

Dry, barking

Temperature

Normal

 Subfebrile

Change of voice

Absent

Hoarse of voice 

Shortness of breath

Expiration