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Question 1

What are a doctors diagnostic goals?

Answer 1

Establish whether a patient has episodic symptoms of airlflow obstruction; Determine whether airflow obstruction is at least partially reversibile and ; exclude alternative Dx

Question 2

NIH guidelines in medical Hx

Answer 2

pattern of symptoms, family history of asthma or allergies, questions about what aggravates symptoms

Question 3

NIH 6 questions for past year

Answer 3

1. sudden severe episode or recurrent wheezing tight chest, short of breath
2. colds that go to chest and last >10 days
3. cough etc during a season?
4. cough etc exposed to environ triggers
5. medications relieve?
6. feel better after meds

Question 4

NIH questions for past 4 weeks

Answer 4

cough etc. waken you? Occur after or during exercise?

Question 5

What should doc find out in detailed resp Hx

Answer 5

types of symptoms; timing, duration, and severity, relationship bt symptoms and pot tirggers; Fx Hx of asthma; descr of home, work and school

Question 6

What does the doc look for in physical exam?

Answer 6

signs of labored breathing; abnormal breath sounds; signs of upper airway inflammation; signs of allergic skin conditions

Question 7

What are signs of labored breathing

Answer 7

Hyperexpansion of the thorax (esp in kids) and or use of accessory breathing muscles

Question 8

What are signs of upper airway inflammation?

Answer 8

increased nasal secretions; mucosal swelling, post nasal drip, nasal polyps

Question 9

What does a spirometer test

Answer 9

Amount of air exhaled and the rate it is done

Question 10

What pulmonary function parameters are evaluated with spirometers?

Answer 10

Forced Vital Capacity (FVC0 Forced Expiratory vol in 1 sec(FEV1); forced expiratory vol in 6 sec (FEV6); FEV1 to FVC ration

Question 11

Who determines ref values?

Answer 11

American Thoracic Society

Question 12

What is forced vital capacity?

Answer 12

Max vol of air forcibly exhaled from the point of max inhalation

Question 13

How is airflow obstruction demonstrated by Spirometry?

Answer 13

Decrease in FEV1 and the FEV1/FVC ratio relative to reference or predicted values

Question 14

How is reversibility measure in spirometry

Answer 14

Increase in FEV1by 12% and an increase of 200mL from baseline after inhalation of a short-acting bronchodilator

Question 15

What are Peak Flow Meters designed for

Answer 15

Disease monitoring; not asthma Dx-too wide a variable

Question 16

What are some other tests used?

Answer 16

Bronchoprovocation; allergy testing;

Question 17

What is bronchoprovocaion?

Answer 17

Use methacholine, histamine, or exercise to rule out asthma

Question 18

When establ a Dx of asthma docs try to establish presence of episodic symtoms of airflow obstruction; presence of partially reversibile airflow obstruction and ???

Answer 18

Exclude alt. Dx

Question 19

A spirometer measures a number of resp parameters including?

Answer 19

The amount of air exhaled and the rate at which it was exhaled

Question 20

Spriometry results..decrease in FEV1, 5 decrease in ratio of FEV1 and FVC . this means?

Answer 20

Demonstrate mild airflow obstruction