Diagnosis

Because of the lack of any specific symptom or sign to define asthma by history or physical examination, some patients are mistakenly thought to have asthma. Numerous other diseases must be considered in the differential diagnosis of asthma (Box 20-2). Although parental history of asthma is present in half of children with asthma, the positive predictive value of this history ranges from 11% to 37% (Burke et al., 2003). The diagnosis of asthma should occur in three stages. First, suggestive symptoms referable to the chest with precipitating factors should raise the possibility of asthma. Second, further testing should be performed to confirm the diagnosis. Third, the patient should have symptomatic improvement with the appropriate asthma therapy (see Classification). When all the stages have been performed and meet the criteria, the diagnosis of asthma can be made.

Table 20-3 Ophthalmic Solutions Useful in the Treatment of Allergic Conjunctivitis

Drug (Brand)

Formulation

Dosage

Mast Cell Stabilizers

Cromolyn (Opticrom)

4%

1-2 gtt OU every 4-6 hr daily

Lodoxamide (Alomide)

0.1%

1 gtt OU qid

H, Histamine Blockers

Emedastine (Emadine)

0.05%

1 gtt OU qid

Levocabastine (Livostin)

0.5 mg/mL

1 gtt OU bid

Combination Stabilizers/Blockers

Ketotifen (Zaditor)

0.025%

1 gtt OU bid 8-12 hr apart

(Zyrtec Itchy Eye)

0.025%

1 gtt OU bid 8-12 hr apart

(Claritin Eye)

0.025%

1 gtt OU bid 8-12 hr apart

Epinastine (Elestat)

0.05%

1 gtt OU bid

Olopatadine (Patanol)

0.1%

1 gtt OU bid 6-8 hr apart

(Pataday)

0.2%

1 gtt OU qd

Azelastine (Optivar)

0.05%

1 gtt OU bid

Nonsteroidal Anti-Inflammatory Drugs

Ketorolac (Acular)

0.5%

1 gtt OU qid

OU, Each eye; gtt, drops; qid, four times daily; bid, twice daily; qd, once daily.

Box 20-2 Differential Diagnosis of Asthma

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