A dry or irritating cough may be persistent, recurrent or worse at night. Some people have cough-predominant asthma without obvious wheezing.
Private asthma specialist in London
Asthma Diagnosis and Treatment in London
Specialist assessment for suspected, difficult-to-control and severe asthma, with objective diagnostic testing and personalised treatment from Dr Ricardo José.
- FeNO and lung-function testing
- Personalised inhaler treatment
- Assessment of asthma triggers
Understanding the condition
What is asthma?
Asthma is a long-term condition in which the airways become inflamed, sensitive and intermittently narrowed, making it more difficult for air to move in and out of the lungs.
Asthma symptoms can vary over time. A person may feel well between episodes but develop coughing, wheezing, breathlessness or chest tightness when airway inflammation and narrowing increase.
During an asthma episode, the muscles surrounding the airways can tighten, the airway lining may swell and mucus production may increase. Together, these changes narrow the breathing passages and can produce turbulent airflow and wheezing.
Asthma can begin during childhood or adulthood. Its pattern, severity, inflammatory type and triggers differ between patients, which is why accurate investigation is important before establishing a long-term treatment plan.
Recognising possible asthma
What are the symptoms of asthma?
Asthma symptoms often vary from day to day and may become worse at night, early in the morning, during exercise or after exposure to a trigger.
Wheezing is a musical or whistling sound, often most noticeable while breathing out, caused by air moving through narrowed airways.
Breathlessness may develop during exercise, at rest or after exposure to allergens, respiratory infections, smoke, pollution or cold air.
Patients may describe pressure, restriction or a band-like sensation across the chest, sometimes accompanied by difficulty taking a satisfying breath.
Features that make asthma more likely
- Symptoms that come and go
- Symptoms that are worse at night or early morning
- Several respiratory symptoms occurring together
- Symptoms after exercise, cold air or allergen exposure
- A personal or family history of allergic disease
Risk factors and triggers
What causes asthma?
Asthma usually develops through a combination of genetic susceptibility, airway inflammation and exposure to factors that initiate or worsen respiratory symptoms.
Atopy and sensitisation
Allergies
Environmental allergens can trigger allergic airway inflammation. Symptoms may begin in the nose and upper airway before involving the lower airways. Allergic asthma may occur alongside hay fever, eczema or other allergic conditions.
Respiratory infections
Viral and bacterial infections can trigger worsening symptoms and acute attacks. Common triggers include colds, influenza, COVID-19, RSV, bronchitis and sinusitis.
Environmental conditions
Smoke, air pollution, workplace fumes, mould, damp, cold air and sudden weather changes can aggravate asthma or contribute to irritant and occupational asthma.
Emotions and stress
Strong emotions, laughter, anxiety, grief and panic can alter breathing patterns or trigger respiratory symptoms in some people.
Genetics
Asthma is more common in people with a family history of asthma or allergic disease, reflecting an inherited susceptibility.
Exercise and medicines
Exercise can reveal poorly controlled asthma. Aspirin, non-steroidal anti-inflammatory medicines and beta blockers may also trigger symptoms in susceptible patients.
Objective diagnosis
Tests Dr José uses to identify asthma
Asthma may be suspected from the clinical history, but objective evidence should be obtained whenever possible before establishing the diagnosis and committing a patient to long-term treatment.
Symptoms alone do not always confirm asthma
Cough, breathlessness, wheeze and chest tightness can also occur in other respiratory, cardiac, upper-airway and breathing-pattern disorders. Test results are therefore interpreted alongside the history, examination and response to treatment.
Airway inflammation
FeNO test
Fractional exhaled nitric oxide testing involves breathing steadily into a specialised machine that measures nitric oxide in exhaled breath. A raised result supports type 2 or eosinophilic airway inflammation.
How it helps
FeNO can support diagnosis, help identify an inflammatory asthma phenotype and provide useful information when considering corticosteroid treatment.
Lung function
Spirometry and reversibility
Spirometry measures how much air the lungs can hold and how quickly air can be breathed out. Results may be normal between episodes, or they may show airflow obstruction.
Bronchodilator response
Spirometry may be repeated after an inhaled bronchodilator. Significant improvement in airflow provides objective evidence of variable airway narrowing.
Variable airflow
Peak-flow monitoring
A peak-flow meter measures how quickly a person can breathe out. Measurements may be taken twice daily for approximately two weeks to look for variation in airflow.
How it helps
Significant variation between readings can support a diagnosis when symptoms and other investigations remain suggestive.
Excluding other causes
Chest imaging
Chest X-rays are commonly normal in asthma and do not confirm the diagnosis. Imaging can nevertheless help identify complications or alternative explanations for respiratory symptoms.
Possible findings
Hyperinflation, bronchial-wall thickening or focal atelectasis may occur, but none of these findings is specific to asthma.
Allergic triggers and inflammatory phenotype
Allergy and blood testing
Allergy testing does not diagnose asthma on its own. However, it can identify sensitisation to common airborne allergens that may trigger or aggravate airway inflammation and help explain seasonal, environmental or exposure-related symptoms.
Blood eosinophils, total immunoglobulin E and selected blood tests may help Dr José characterise the inflammatory pattern, particularly when assessing difficult or severe asthma.
Tests that may be considered
Specific IgE blood testing
Looks for sensitisation to pollen, house-dust mites, moulds, animal proteins and other selected allergens.
Skin-prick testing
Assesses immediate allergic sensitisation when clinically appropriate and available.
Blood eosinophils
May support identification of eosinophilic or type 2 airway inflammation.
Total immunoglobulin E
Can contribute to severe allergic-asthma assessment and biological treatment eligibility.
Testing airway sensitivity
Bronchial provocation testing
Bronchial provocation, also called bronchial challenge testing, is particularly useful when the clinical history strongly suggests asthma but FeNO, spirometry, reversibility and peak-flow monitoring have not provided a clear diagnosis.
What happens during the test?
Lung function is measured before and after controlled exposure to a substance or activity that can temporarily narrow sensitive airways. The challenge may use methacholine, histamine, mannitol or exercise.
Methacholine or histamine
Increasing controlled doses are inhaled while spirometry is repeated. A significant fall in airflow demonstrates bronchial hyper-responsiveness.
Mannitol challenge
Inhaled dry-powder mannitol can identify airway hyper-responsiveness through an indirect inflammatory stimulus.
Exercise challenge
Lung function is assessed before and after controlled exercise when exertion consistently triggers respiratory symptoms.
Interpreting the result
A positive result supports asthma when considered with the clinical history. A negative result can make active asthma less likely.
When Dr José may recommend it
Dr José may arrange bronchial provocation when asthma remains clinically likely despite normal tests between episodes, when exercise-related asthma is suspected or before escalating long-term treatment.
Bronchial challenge testing is performed under controlled clinical conditions. Certain medicines may need to be withheld beforehand, but only according to the testing centre’s instructions.
Adult diagnostic pathway
Asthma diagnosis usually develops through a sequence of evidence
The tests required depend on the clinical history, current treatment and the results already available. Not every patient needs every test.
-
01
Clinical assessment
Symptoms, triggers, examination and alternative diagnoses.
-
02
Inflammation testing
FeNO and blood eosinophils where appropriate.
-
03
Airflow assessment
Spirometry, reversibility and peak-flow monitoring.
-
04
Challenge testing
Bronchial provocation when the diagnosis remains uncertain.
Personalised disease control
Asthma treatment
Asthma treatment aims to suppress airway inflammation, relieve variable airway narrowing, prevent attacks and enable normal activities with the lowest effective treatment burden.
Inhaled medication
Inhalers
Inhalers deliver medication directly to the airways. The best inhaler depends on the required medicines, symptom pattern, inhalation technique, dexterity and personal preference.
Inhaled corticosteroids
Inhaled corticosteroids reduce airway inflammation and are the foundation of asthma treatment. Regular anti-inflammatory treatment helps prevent symptoms and asthma attacks.
Bronchodilators
Bronchodilators relax airway smooth muscle and help open narrowed airways. Longer-acting bronchodilators are generally used with an inhaled corticosteroid.
AIR and MART inhalers
Some combination inhalers provide both anti-inflammatory and bronchodilator treatment as reliever or maintenance-and-reliever therapy.
Additional pharmacological treatment
Oral medication
Tablets may be added when asthma is not adequately controlled with an appropriate inhaled-treatment regimen.
- Leukotriene receptor antagonists Medicines such as montelukast may help selected patients, including some with allergic or exercise-related symptoms.
- Theophylline This may be considered in selected circumstances but requires attention to interactions, side effects and monitoring.
- Oral corticosteroids Short courses may be required for significant asthma attacks. Long-term use is avoided where possible.
Non-drug support
Therapies and self-management
Medication works best when combined with education, correct inhaler technique, trigger management and a written personalised asthma action plan.
Respiratory physiotherapy
May assist patients with excessive mucus, breathing-pattern dysfunction or difficulty clearing respiratory secretions.
Inhaler-technique review
Incorrect inhaler use is common and can significantly reduce the amount of medication reaching the lungs.
Trigger and lifestyle management
Smoking cessation, exercise, healthy weight, vaccination and management of allergic rhinitis may improve control.
Evidence that acupuncture, homeopathy or dietary supplements
directly control asthma is limited. They should not replace
prescribed anti-inflammatory treatment.
Targeted treatment for severe asthma
Biological injections
Biological therapies, also known as biologics or monoclonal antibodies, are targeted add-on treatments for selected people with severe asthma. They are considered when asthma remains poorly controlled despite optimised inhaled treatment and other appropriate medication.
Biologics interrupt specific immune pathways involved in airway inflammation. The most appropriate treatment depends on asthma phenotype, biomarkers, attack history, current treatment and other clinical features.
Allergic pathway
Anti-IgE treatment
May be considered for eligible patients with severe allergic asthma, allergen sensitisation and an appropriate IgE profile.
Eosinophilic pathway
Anti-IL-5 or anti-IL-5 receptor treatment
Targets pathways involved in eosinophil production, survival or activity.
Type 2 inflammation
Anti-IL-4 receptor treatment
Blocks signalling associated with interleukin-4 and interleukin-13.
Upstream inflammatory signalling
Anti-TSLP treatment
Targets an upstream epithelial signal involved in initiating several inflammatory pathways.
Assessment before biological treatment
- Confirming that the diagnosis of asthma is secure
- Reviewing inhaler technique and treatment adherence
- Checking environmental or occupational triggers
- Treating relevant contributing medical conditions
- Reviewing eosinophils, FeNO, allergy results and IgE
- Documenting attacks, steroid exposure and hospital care
Possible benefits for an eligible patient
Fewer asthma attacks
Reduced oral-steroid exposure
Improved symptom control
Better quality of life
Fewer emergency visits
Improved lung function in some patients
Biological treatment does not automatically replace other asthma
medication. It is normally initiated through a specialist
severe-asthma service, with treatment response reviewed regularly.
Every patient should understand how to manage worsening symptoms
A personalised asthma action plan explains regular treatment, how to recognise deteriorating control and when to seek urgent medical help.
Specialist respiratory care
Why I should see Dr Ricardo José for asthma
Dr Ricardo José provides specialist-led investigation and personalised management for people with suspected asthma, persistent symptoms or asthma that is not adequately controlled.
A diagnosis based on evidence, not symptoms alone
Asthma symptoms can overlap with inducible laryngeal obstruction, dysfunctional breathing, chronic cough, reflux, allergic disease, cardiac disease and other respiratory disorders. Dr José reviews the complete clinical picture before recommending long-term treatment.
Detailed diagnostic assessment
Clinical history, examination, FeNO, spirometry, peak-flow monitoring and further testing where required.
Asthma phenotype assessment
Identification of eosinophilic, allergic and other patterns that may influence treatment selection.
Inhaler optimisation
Review of medication choice, inhaler technique, adherence and treatment effectiveness.
Trigger and allergy review
Investigation of environmental, allergic, occupational and exercise-related symptom patterns.
Difficult and severe asthma review
Reassessment of diagnosis, contributing conditions, exacerbation risk and specialist therapies.
Personalised management plan
A clear strategy with monitoring, follow-up and guidance for deteriorating symptoms.
Asthma assessment in London
Are asthma symptoms affecting your breathing, sleep or exercise?
Arrange a specialist consultation for investigation of suspected asthma, review of an existing diagnosis or help with symptoms that remain poorly controlled.
