Lesson 2: Asthma Diagnosis, Control and Long-Term Treatment

Course 04: Respiratory Medicine and Infectious Disease

Lesson 2 of 14. Explore the diagnostic and management frameworks, work through the case, and finish the linked 10-question practice set. Urgent presentations require an emergency-care pathway and review of local professional scope.

Diagnosis and phenotype

• Asthma combines variable symptoms (wheeze, cough, dyspnea, chest tightness) with evidence of variable expiratory airflow limitation; test before or while arranging treatment when safe.
• Bronchodilator reversibility or peak-flow variability can support diagnosis; normal spirometry between attacks does not exclude asthma and may require repeat testing.
• Identify allergic and nonallergic triggers, occupational exposure, rhinitis, eosinophilic features, obesity, reflux and alternative diagnoses including vocal cord dysfunction.

Guideline-based maintenance

• GINA 2026 recommends inhaled corticosteroid (ICS)-containing treatment for adults and adolescents with asthma, and advises against SABA-only treatment.
• For adults and adolescents, low-dose ICS-formoterol as anti-inflammatory reliever is a preferred strategy in appropriate jurisdictions; MART (maintenance-and-reliever) may be used for more persistent disease.
• Do not assume every inhaled LABA is an approved reliever: reliever/MART strategies require the appropriate specific ICS-formoterol product and locally approved dosing.

Monitoring and difficult asthma

• Assess recent symptoms, nighttime waking, reliever use, activity limitation, exacerbations and risk factors, plus spirometry when feasible; symptom control and future risk are distinct.
• Before escalating treatment, check inhaler technique, adherence, access/cost, environmental exposures, co-morbidities and whether the diagnosis is correct.
• Severe asthma may warrant specialist phenotyping and targeted biologic therapy, while repeated oral corticosteroids carry cumulative adverse effects.

Education and follow-up

• Provide a written personalized action plan that specifies baseline controller, worsening symptoms, when to seek urgent help and post-exacerbation follow-up.
• Use teach-back and a physical device demonstration to check inhaler technique; identify barriers and agree on realistic goals.
• Counsel on smoke/vape exposure reduction, appropriate vaccines, occupational risk review and symptom-trigger monitoring without over-restricting exercise.

Applied clinical case

A 24-year-old uses a salbutamol inhaler several times weekly, has nighttime cough twice monthly, no controller inhaler and normal spirometry today.

Clinical self-check

1. What confirms variable expiratory limitation?
2. Why is isolated SABA use unsafe?
3. How do you distinguish poor adherence from treatment failure?

Current guidance and further learning

• GINA 2026: Asthma strategy and summary guide (external)
• Canadian Thoracic Society guideline library (external)

Downloadable learning materials

• Respiratory and Sepsis Emergency Red Flags (PDF)
• Asthma and COPD: Diagnosis, Inhaler Care and Exacerbation Guide (PDF)
• Pneumonia, TB and Viral Infection Decision Guide (PDF)
• Pulmonary Diagnostics and Infectious Safety Reference (PDF)
• Complete Respiratory Medicine Handbook - 14 Lessons (PDF)