Every patient of suspected asthma should be diagnosed objectively by Spirometry Concurrently Sinusitis Rhinitis to be ruled out by or imaging techniques.Atopy being common serum IgE levels may also be estimated though it’s not always the case.Infection being a common trigger rule it out by blood or sputum tests. Gastroesophageal Reflux is seen in 30% of patients It must be enquired in history and May be referred to Gastroenterologist.its features are occurrence of symptoms on lying down or after heavy meal with heartburn or bloating.Upper gastrointestinal endoscopy helps in discovering hiatus hernia in a few of the obese . Obese patients may also have undisclosed sleep apnoea characterised by snoring choking fatigue lack of attention concentration.Polysomnography may be required to diagnose and grade. Acute asthma to be treated by regular assessment in hospital to prevent its worsening to critical care stage.

Shortness of breath sudden or progressive may be the only sign while in some patients it’s just cough. Wheeze sneeze and blocked nose are other features. One should not forget the confusion which heart failure can cause.Heart failure requires immediate attention. Triggers are best observed by the patient herself Sometimes they are easily avoidable. Inhalers are best way to deliver anti asthma medication Technique of using them must be thoroughly learnt They are not habit forming .Complications and side-effects are few.