Early diagnosis gives better outcomes – Taking control of asthma from the start

Without early recognition and proper treatment, asthma can worsen over time. That is the message of Dr. Matteo Bonini, Professor of Respiratory Medicine at the Sapienza University of Rome. 

According to the renowned clinician–researcher, asthma must be diagnosed early, treated, and managed properly to avoid long-term damage. 

How medicine currently approaches the treatment of asthma – an inflammatory disease of the airways – has shifted as science has developed, explains Professor Bonini. 

“Emphasis is increasingly on recognizing it early and treating it properly from the beginning, rather than just responding to symptoms.”

When should you take symptoms seriously?

Bonini says that determining if you have asthma may not be immediately obvious because symptoms can easily be mistaken for other conditions. However, even mild or occasional symptoms may indicate underlying inflammation in the airways and should not be ignored.

Shortness of breath, coughing and wheezing are among the most common symptoms of asthma. These may be triggered by allergens, pollutants, respiratory infections, or laughter and vary significantly between individuals and across different natural and built environments. 

“Typical symptoms at night may be particularly suggestive of a diagnosis of asthma,” Bonini says.

Symptoms also fluctuate and may not reflect how severe the condition really is. They are highly subjective and there is often a weak correlation between how severe a person perceives their symptoms to be and the actual severity of the disease, Bonini explains.

For this reason, diagnosis should combine clinical history with objective testing, such as lung function assessment, ideally carried out by a respiratory specialist. A family history of asthma, allergies, or early-life wheezing can also increase the likelihood of the condition.

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The aim is long-term control, rather than simply relieving symptoms when they occur.

Irreversible changes

Anti-inflammatory treatment should become the norm even in mild cases, because aside from the potential for long-term damage, patients may experience severe exacerbations even if symptoms occur only infrequently. 

“Without diagnosis and treatment, this chronic state of inflammation in the lining of the airways can cause recurrent flare-ups, long-term lung damage, and in more severe cases, life-threatening respiratory failure,” Bonini explains.

Untreated asthma can lead to “airway remodelling”, which is an irreversible structural change of the airways that includes thickened airway walls, mucus plugging and narrowing of the air pipes. This causes blockages and progressive loss of lung function.

Dr. Bonini’s message of achieving optimal control is supported by the Global Initiative for Asthma (GINA), on whose Science Committee he sits. 

The latest guidance advises that all adults and adolescents with asthma receive medicine containing inhaled corticosteroid (ICS) and not only a short-acting beta-2 agonist as a reliever.

From diagnosis to long-term control

Early diagnosis is the first step towards effective management. With the right treatment, asthma can be well controlled. In doing so, the risks are reduced and people can lead full and active lives. 

The purpose of inhaled corticosteroids is to target the underlying airway inflammation, Bonini explains. 

“The aim is long-term control, rather than simply relieving symptoms when they occur.” 

He emphasizes that it’s common for asthma sufferers to only treat the symptoms with short-acting bronchodilators, but that goes against current guidance. 

Alongside medication, management should be tailored to the individual. A written asthma action plan can help patients recognize worsening symptoms, adjust treatment and know when to seek medical help. This is stressed in the most recent GINA guidelines. 

According to Bonini, patients often struggle with adhering to their prescribed course of treatment, and some face challenges with inhaler use, which can reduce treatment effectiveness. 

“Following medical advice and ensuring proper inhalation techniques are essential. Inhaling properly is an important part of management of the condition in tandem with consistent use of medication,” says Bonini. 

Early diagnosis and consistent treatment go a long way – protecting lung health, reducing risk and helping people live well with asthma.