SHAHEED BENAZIR BHUTTO WOMEN

UNIVERSITY PESHAWER

DIAGNOSTIC TECHNIQUES OF ASTHMA IN CHILDREN AND

ADULTS

SUBMITTED BY:
FATIMA FAROOQ
SEMESTER 8TH
ENROLLMENT NO:
ZG-27(LEB)U/22

DEPARTMENT OF ZOOLOGY
SESSION: 2022-2024
 SHAHEED BENAZIR BHUTTO WOMEN
UNIVERSITY PESHAWER

SUPERVISOR CERTIFICATE

Certificate that Mrs. Fatima Farooq D/O Ghulam Farooq, student of Department of

Zoology has successfully completed internship report entitled: “Diagnostic Techniques of

Asthma in Children and Adults’’ in Lady Reading Hospital Peshawar under my

supervisor within prescribed time.

Supervisor:

___________________
Saira Saleem
(Assistant professor)

Countersigned By:

------------------------------------------
Incharge Department of Zoology
 DEDICATION

I dedicated this work to my lovely parents, brother and to me my teachers whose love,

supports and prays have always been source of strength for me.
 Table of Contents
LIST OF ABBREVATIONS ................................................................................................ i

LIST OF FIGURES .............................................................................................................. ii

ACKNOWLWGMENTS .................................................................................................... iii

PREFACE ............................................................................................................................ iv

ABSTARACT ....................................................................................................................... v

1. INTRODUCTION ......................................................................................................... 1

1.1. Overview .................................................................................................................. 1

1.1.1. Epidemiology ................................................................................................... 1

1.1.2. Pathophysiology ............................................................................................... 2

1.1.3. Risk Factors ...................................................................................................... 2

1.2. Objectives ................................................................................................................ 2

1.3. Scope ........................................................................................................................ 2

2. BACKGROUND............................................................................................................ 4

2.1. Overview of Pediatric Asthma ................................................................................. 4

2.1.1. Epidemiology ................................................................................................... 4

2.1.2. Pathophysiology ............................................................................................... 4

2.2. Clinical Presentation and Symptomatology ............................................................. 5

2.3. Traditional Diagnostic Techniques .......................................................................... 5

2.4. Emerging Diagnostic Techniques ............................................................................ 6

3. METHODOLOGY ........................................................................................................ 7

3.1. Clinical evaluation ................................................................................................... 7

3.1.1. Detailed Medical History.................................................................................. 7

 3.1.2. Previous Medical Interventions ........................................................................ 8

3.1.3. Physical Examination ....................................................................................... 8

3.1.4. Other Systems ................................................................................................... 8

3.1.5. Asthma Control Test (ACT) and Childhood Asthma Control Test (C-ACT) .. 9

3.2. Pulmonary Function Tests (PFTs) ........................................................................... 9

3.2.1. Spirometry ........................................................................................................ 9

3.3. Allergy Testing in the Diagnosis of Pediatric Asthma .......................................... 10

3.3.1. Skin Prick Testing (SPT) ................................................................................ 11

3.3.2. Serum Specific IgE Testing (RAST and ImmunoCAP) ................................. 12

3.3.3. Component-Resolved Diagnostics (CRD)...................................................... 12

4. DISCUSSION .............................................................................................................. 13

4.1. Effectiveness of Diagnostic Techniques ................................................................ 13

4.1.1. Clinical Evaluation ......................................................................................... 13

4.1.2. Pulmonary Function Tests (PFTs): ................................................................. 13

4.1.3. Allergy Testing ............................................................................................... 13

5. CONCLUSION ............................................................................................................ 15

REFERENCES ................................................................................................................... 16
 LIST OF ABBREVATIONS
PFT: Pulmonary Function Test

SPT: Skin Prick Testing

CRD: Component-Resolved Diagnostics

RBC: Red blood cells

GINA: Global Initiative for Asthma

PEF: Peak Expiratory Flow

i
 LIST OF FIGURES
Figure 1.1 Asthma in children ............................................................................................................. 1

Figure 3.1 Clinical evaluation ............................................................................................................. 7

Figure 3.2 Pulmonary Function Tests ................................................................................................. 9

Figure 3.3 Allergy Testing in the Diagnosis of Pediatric Asthma .................................................... 11

ii
 ACKNOWLWGMENTS
First of all thanks to ALMIGHTY ALLAH for giving me strength and courage

to complete my internship and to learn a lot during my internship. I would like to

acknowledge my supervisor Mrs. Saira Saleem (Assistant Professor) for the cooperation

and help she provided for completing this internship report. I also acknowledge the

authorities and staff of lab Pathology in Lady Reading Hospital Peshawar for allowing

us to work there and gives us chance to learn a lot from experienced staff members and be

benefitted by their skills.

Finally, I would like to express my heartfelt thanks to my parents and loving

ones for their support and patience that enabled me to complete this work.

iii
 PREFACE
The present report is the outcome of internship. The objective of internship was to know the

practical work. The practical knowledge is different from the bookish knowledge. The

objective of this report an introduction to different diagnostic techniques used usually in

pathology lab. The internship has increased my knowledge of practical work and also

enhanced my capability to correctly diagnose human problems. Now, we are able to

perform all these techniques without any help in the presence of all required mater.

iv
 ABSTARACT
The main purpose of doing internship was to learn about diagnostic technique in the lab and

analyse data for better interpretation for correct diagnosis. This report examined the

diagnostic techniques used to identify asthma in children, highlighting the importance of

early and accurate diagnosis to improve long-term outcomes. It explores traditional

methods and emerging technologies, assessing their effectiveness, limitations, and

applications. By reviewing current literature, clinical guidelines, and case studies, this

research aims to provide a framework for integrating advanced diagnostic approaches in

pediatric asthma care.

v
Chapter 1 Introduction

INTRODUCTION
1.1. Overview

Asthma is a chronic respiratory disease that affects millions of children worldwide. It is

characterized by recurring episodes of wheezing, breathlessness, chest tightness, and
coughing, particularly at night or early in the morning. The prevalence of asthma has been
increasing over the past few decades, making it a significant public health concern.

Figure 1.1 Asthma in children

1.1.1. Epidemiology

Asthma affects an estimated 339 million people globally, with a significant proportion
being children. The prevalence varies by region, with higher rates in developed countries
compared to developing ones.
Asthma can occur at any age, but it most commonly starts in childhood. Boys are more
likely to develop asthma than girls during childhood, but this trend reverses in adulthood.
Impact on Quality of Life: Asthma can severely impact a child's quality of life, affecting
their physical activities, school attendance, and social interactions. It is also a leading cause
of hospitalizations and emergency room visits among children.

1
Chapter 1 Introduction

1.1.2. Pathophysiology

Airway Inflammation: Asthma involves chronic inflammation of the airways, leading to

hyperresponsiveness and obstruction. During an asthma attack, the muscles around the
airways tighten, narrowing the airways and making breathing difficult. Long-term,
unmanaged asthma can lead to structural changes in the airways, known as airway
remodeling, which can cause persistent airflow limitation.

1.1.3. Risk Factors

A family history of asthma or other allergic conditions increases the risk of developing
asthma. Exposure to allergens (such as dust mites, pet dander, and pollen), tobacco smoke,
air pollution, and respiratory infections are significant environmental risk factors. Diet,
physical activity, and obesity can influence asthma risk and severity.

1.2. Objectives

The primary objective of this report is to explore and evaluate the various diagnostic
techniques for asthma in children. Accurate and early diagnosis is crucial for effective
asthma management and improving the quality of life for affected children.
 To provide a detailed analysis of clinical evaluation methods, pulmonary function tests
(PFTs), and allergy testing
 To assess the effectiveness and limitations of each diagnostic technique in the pediatric
population
 To highlight the importance of integrating various diagnostic techniques for a
comprehensive approach to asthma diagnosis
 To offer practical recommendations for healthcare professionals to improve the
accuracy and efficiency of asthma diagnosis in children
By achieving these objectives, this report aims to contribute to the advancement of
diagnostic approaches for pediatric asthma, ultimately improving the quality of care and
health outcomes for children with asthma.

1.3. Scope

The scope of this report includes a comprehensive examination of the following diagnostic
techniques:
Clinical Evaluation: Detailed medical history, physical examination, and symptom-based
questionnaires.
Pulmonary Function Tests (PFTs): Spirometry, peak expiratory flow (PEF) measurement,
impulse oscillometry (IOS), and fractional exhaled nitric oxide (FeNO).

2
Chapter 1 Introduction

Allergy Testing: Skin prick testing (SPT), serum specific IgE testing, component-resolved
diagnostics (CRD), and patch testing.

3
Chapter 2 Background

BACKGROUND
2.1. Overview of Pediatric Asthma

Asthma is one of the most common chronic respiratory diseases affecting children

worldwide. It is characterized by chronic inflammation of the airways, leading to recurrent

episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or

early in the morning. The prevalence of asthma has been increasing, making it a significant

public health concern.

2.1.1. Epidemiology

The prevalence of asthma in children varies globally, with higher rates observed in

developed countries compared to developing ones. According to the Global Initiative for

Asthma (GINA), approximately 7-10% of children worldwide are affected by asthma.

Factors contributing to this variation include genetic predisposition, environmental factors,

and socio-economic status.

2.1.2. Pathophysiology

Asthma involves a complex interplay between genetic and environmental factors that lead

to chronic inflammation and hyper-responsiveness of the airways. Key elements of asthma

pathophysiology include:

 Airway Inflammation: Involves multiple inflammatory cells (eosinophils, mast

cells, T-lymphocytes) and mediators (cytokines, chemokines) that cause swelling

and increased mucus production.

 Airway Hyper-responsiveness: Increased sensitivity of the airways to various

stimuli, leading to bronchoconstriction.

4
Chapter 2 Background

 Airway Remodeling: Structural changes in the airway walls, including thickening of

the basement membrane and increased smooth muscle mass, which contribute to

chronic airflow obstruction.

2.2. Clinical Presentation and Symptomatology

Asthma symptoms in children can vary widely in frequency and severity. Common

symptoms include:

 Wheezing: A high-pitched whistling sound during breathing, particularly during

exhalation.

 Coughing: Persistent cough, often worse at night or early morning.

 Shortness of Breath: Difficulty breathing or feeling out of breath.

 Chest Tightness: Sensation of pressure or tightness in the chest.

2.3. Traditional Diagnostic Techniques

The traditional approach to diagnosing asthma in children involves a combination of

clinical evaluation, pulmonary function tests, and allergy testing. Key components include:

 Clinical Evaluation: Detailed medical history and physical examination to identify

characteristic symptoms and potential triggers.

 Pulmonary Function Tests: Spirometry and peak expiratory flow (PEF)

measurements to assess lung function and airway obstruction.

 Allergy Testing: Skin prick testing (SPT) and serum IgE levels to identify allergen

sensitivities.

5
Chapter 2 Background

2.4. Emerging Diagnostic Techniques

Advancements in medical technology have led to the development of new diagnostic tools

that can enhance the accuracy and efficiency of asthma diagnosis. These include:

 Non-Invasive Biomarkers: Fractional exhaled nitric oxide (FeNO) and exhaled

breath condensate (EBC) to assess airway inflammation.

 Imaging Techniques: High-resolution computed tomography (HRCT) and lung

ultrasound for detailed visualization of airway structures.

 Molecular and Genetic Techniques: Genomic and proteomic profiling to identify

genetic predispositions and molecular markers associated with asthma.

6
Chapter 3 Methodology

METHODOLOGY
3.1. Clinical evaluation

Clinical evaluation is the cornerstone of asthma diagnosis in children, involving a detailed

medical history, physical examination, and the use of symptom-based questionnaires. This

comprehensive approach helps clinicians identify characteristic asthma symptoms, assess

their severity, and rule out other potential causes of respiratory issues.

Figure 3.1 Clinical evaluation

3.1.1. Detailed Medical History

A thorough medical history is essential for identifying patterns and triggers of asthma

symptoms. Key components of the medical history include:

Family History: Inquire about any family history of asthma, allergic rhinitis, eczema, or

other atopic conditions, as genetic predisposition plays a significant role in asthma

development.

7
Chapter 3 Methodology

Symptom History: Document when the symptoms first appeared and how long they have

been present.

Exercise and Physical Activity: Assess whether exercise triggers symptoms, indicating

exercise-induced bronchoconstriction.

3.1.2. Previous Medical Interventions

Review any previous or current use of asthma medications, including inhalers,

corticosteroids, and bronchodilators. Document any history of hospitalizations, emergency

room visits, or previous diagnostic tests related to respiratory issues.

3.1.3. Physical Examination

A comprehensive physical examination is crucial for identifying signs of asthma and ruling

out other conditions.

General Observation: Observe the child's general appearance, noting any signs of distress,

fatigue, or cyanosis (bluish discoloration of the skin due to lack of oxygen).

Respiratory Examination: Use a stethoscope to listen for wheezing, crackles, or

decreased breath sounds. Note the presence, location, and timing of these sounds (e.g.,

inspiratory or expiratory wheezing).

3.1.4. Other Systems

 Cardiovascular Examination: Assess heart sounds and check for any signs of

cardiac involvement, such as a heart murmur, which may mimic or coexist with

asthma.

 Skin Examination: Look for signs of atopic dermatitis (eczema) or other allergic

manifestations that are commonly associated with asthma.

8
Chapter 3 Methodology

3.1.5. Asthma Control Test (ACT) and Childhood Asthma Control Test (C-ACT)

 ACT: Designed for children aged 12 and older, this questionnaire assesses asthma
control over the past four weeks through questions about activity limitations,
frequency of symptoms, and medication use.
 C-ACT: For children aged 4 to 11, this tool involves both the child and the parent
in assessing symptom frequency, activity limitations, and nocturnal symptoms.

3.2. Pulmonary Function Tests (PFTs)

Pulmonary Function Tests (PFTs) are crucial for assessing lung function in children
suspected of having asthma. These tests measure various aspects of lung function, including
airflow, lung volumes, and the ability of the lungs to exchange gases. PFTs help diagnose
asthma, determine its severity, and monitor response to treatment. Key PFTs used in
pediatric asthma diagnosis include spirometry, peak expiratory flow (PEF) measurement,
and bronchodilator responsiveness testing.

Figure 3.2 Pulmonary Function Tests

3.2.1. Spirometry

Spirometry is the most widely used pulmonary function test and provides essential
information about airflow obstruction. It measures the volume of air a patient can exhale
forcefully after taking a deep breath.

9
Chapter 3 Methodology

Technique

 Preparation: Ensure the child is comfortable and understands the procedure.

Provide clear instructions and, if necessary, demonstrate the technique.

 Maneuver: The child takes a deep breath in, seals their lips around the mouthpiece,
and exhales forcefully and completely into the spirometer.

 Repetitions: Perform at least three acceptable and reproducible maneuvers to

ensure accuracy.

Key Measurements

 Forced Vital Capacity (FVC): The total volume of air exhaled during a forced
breath.

 Forced Expiratory Volume in 1 Second (FEV1): The volume of air exhaled in the
first second of the forced breath.

 FEV1/FVC Ratio: The ratio of FEV1 to FVC, expressed as a percentage. A lower

ratio indicates airflow obstruction.

Interpretation

 Normal Values: Compare the results to age-, sex-, height-, and ethnicity-specific
reference values.

 Obstructive Pattern: Characterized by a reduced FEV1, a normal or reduced FVC,

and a reduced FEV1/FVC ratio.

 Reversibility: A significant improvement in FEV1 (typically an increase of 12%

and 200 mL) after administration of a bronchodilator suggests asthma.

3.3. Allergy Testing in the Diagnosis of Pediatric Asthma

Allergy testing is an integral part of the diagnostic process for asthma in children.
Identifying specific allergens that trigger asthma symptoms can significantly improve
management and outcomes. The following sections detail the key allergy testing methods
used in pediatric asthma diagnosis.

10
Chapter 3 Methodology

Figure 3.3 Allergy Testing in the Diagnosis of Pediatric Asthma

3.3.1. Skin Prick Testing (SPT)

Skin prick testing (SPT) is a widely used method to identify IgE-mediated allergic
reactions. It involves introducing small amounts of allergens into the skin and observing for
a reaction.

Procedure

 Preparation: Ensure the child has not taken antihistamines for at least 48-72 hours
before the test, as they can interfere with results.

 Technique:

11
Chapter 3 Methodology

o The child's forearm or back is cleaned with alcohol.

o Small drops of allergen extracts are placed on the skin.

o A sterile lancet is used to prick the skin through each drop, introducing the
allergen.

 Observation:

o The test site is observed for 15-20 minutes for any reaction.

o A positive reaction is indicated by a raised, red, itchy bump (wheal)

surrounded by a flat red area (flare).

3.3.2. Serum Specific IgE Testing (RAST and ImmunoCAP)

Serum specific IgE testing measures the presence of IgE antibodies to specific allergens in
the blood. Common methods include the radioallergosorbent test (RAST) and
ImmunoCAP.

Procedure

 Blood Sample: A blood sample is drawn from the child.

 Laboratory Analysis: The sample is analyzed for specific IgE antibodies against
various allergens.

3.3.3. Component-Resolved Diagnostics (CRD)

Component-resolved diagnostics (CRD) identify specific proteins within allergens

responsible for allergic reactions. This advanced method can provide a more detailed
allergy profile.

Procedure

 Blood Sample: Similar to serum specific IgE testing, a blood sample is analyzed.

 Laboratory Analysis: The sample is tested for IgE antibodies against individual
allergenic components rather than whole allergens.

12
Chapter 4 Discussion

DISCUSSION
4.1. Effectiveness of Diagnostic Techniques

4.1.1. Clinical Evaluation

 Strengths
 Detailed History: A thorough medical history can reveal patterns and triggers of
asthma symptoms, which is crucial for diagnosis and management.
 Physical Examination: Physical signs such as wheezing and use of accessory
muscles can provide immediate clues to the presence of asthma.
 Symptom-Based Questionnaires: Tools like the ACT and C-ACT offer
quantifiable data on symptom severity and control, helping to track asthma over
time.
 Limitations
 Subjectivity: Clinical evaluation relies heavily on the patient's or parent's recall
and description of symptoms, which can be subjective and variable.
 Non-Specific Symptoms: Symptoms like coughing and wheezing can be
indicative of various respiratory conditions, not just asthma.

4.1.2. Pulmonary Function Tests (PFTs):

 Spirometry
 Strengths: Spirometry provides objective measurements of lung function and is
considered the gold standard for diagnosing asthma.
 Limitations: Young children may have difficulty performing spirometry
correctly, leading to unreliable results. Also, normal spirometry results do not
rule out asthma.

4.1.3. Allergy Testing

 Skin Prick Testing (SPT)

 Strengths: SPT is quick, relatively inexpensive, and provides immediate results.
It helps identify specific allergens that may trigger asthma symptoms.

13
Chapter 4 Discussion

 Limitations: SPT requires a trained professional and carries a small risk of

anaphylaxis.
 Serum Specific IgE Testing
 Strengths: Useful for patients with extensive skin disease or those who cannot
discontinue antihistamines before SPT.
 Limitations: More expensive and less immediate than SPT, with potential for
false positives or negatives.
 Component-Resolved Diagnostics (CRD):
 Strengths: Provides detailed information on specific allergen proteins, allowing
for more precise management of allergies.
 Limitations: Expensive and not yet widely available in all clinical settings.

14
Chapter 5 Conclusion

CONCLUSION
Early and accurate diagnosis of asthma in children is essential for effective management

and prevention of long-term complications. While traditional methods remain fundamental,

integrating advanced diagnostic techniques such as non-invasive biomarkers, imaging, and

molecular profiling can significantly enhance diagnostic precision and clinical outcomes.

This thesis underscores the need for continued research, education, and the adoption of

comprehensive diagnostic approaches in pediatric asthma care.

15
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