20. Asthma Flashcards
Clinical diagnosis
no gold standard diagnostic criteria; diagnosed on the basis of exclusion
Diagnosis
basis of exclusion with presence of:
- wheeze, breathlessness, chest tightness, cough
- variable airflow obstruction
- recent airway hyper responsiveness
- airway inflammation induced
Children diagnosis
- intermittent cough + wheeze
- exercise induced symptoms
** only 1/4 children with symptoms actually have asthma
Using diagnostic tests
- combination of S&S more predictive
- isolated diagnostic test/S&S has poor predictive value
Spirometry - what is it used for? diagnosis with spirometry?
- identify airflow obstruction
- diagnosis: demonstration of airflow variability over short period of time
Spirometry - asymptomatic asthma
- normal spirometry
Spirometry - indication of asthma
obstructive spirometry with positive bronchodilator reversibility increases probability of asthma
- if normal, record PEF at home when symptomatic
Tests for airway inflammation
- evidence supporting is not strong
Diagnosis
- history of episodic symptoms triggered by viral infection or allergen exposure
- exacerbated by cold air, exercise, emotions/stress
- wheeze, chest tightness, dyspnea, cough
- children: Obese/overweight kids 50% of diagnosis
- adults: symptoms triggered by NSAIDs or Beta Blockers
- symptoms worse at night or early AM
- lower FEV1 or PEF during episodes
Asthma vs. COPD
- Age
- Smoking
- Sputum
- Allergies
- Clinical Symptoms
- Disease course
- Co-morbidity
- Spirometry
- Airway inflammation
- Response to corticosteroids
- Age:
- Smoking
- Sputum
- Allergies
- Clinical Symptoms
- Disease course
- Co-morbidity
- Spirometry
- Airway inflammation
- Response to corticosteroids
Asthma Management
- Education, PAAP
- Reduce visit to ER/hospital admission
- improve control, symptoms, work absence, QOL
PAAP
- recognize asthma control assessed by symptoms or peak flow
- 2 or 3 action points if symptoms deteriorate (seek emergency, increased inhaled/oral corticosteroids)
Allergen avoidance
- house dust (chemical, heat, vacuum)
- pet dander (potent provoker)
- smoke (in teens increase risk of persistent asthma)
- air poluution (smog, air quality)
Breathing exercise
behaviour modification:
- breathing exercises
- dysfunctional breathing reduction
- reduce bronchodilator usage
- little to no effect on lung function (does not improve lung function when episodic)
Physiotherapy
- focus on calm, diaphragmatic breathing
- breathing exercises
- inspiratory muscle training
- airway clearance techniques
- cardiopulmonary fitness
- medication
Exercise
- no changes to PEF, FEV 1 or FVC
- improve cardiovascular fitness and work capacity
- incorporate as part of overall wellness
Papworth method: breathing training - functional breathing
- Eliminate dysfunctional breathing (e.g. hyperinflation, hyperventilation patterns; prevent yawning)
- Replace use of inappropriate accessory muscles of reparation
- Emphasis on calm slow nasal expiration (nose breathing > mouth breathing)
- Reduce habits such as yawning, sighing
Papworth method: Breathing exercises - general education
- educate: recognition and physical management of stress responses and interaction with breathing patterns
- relaxation training
- breathing & relaxation techniques into ADL (teach in semi-recumbent, to sitting, to standing, and then during daily activities/speach)
Pharmacological management: medications (COPD vs. Asthma)
Asthma = short acting (rescue) = corticosteroids (and beta agonists when required)
** know the classes of drugs used to manage
Pharmacological management: what are we aiming to control?
- no daytime symptoms
- no night time awakening
- no need for rescue meds
- no attacks
- no functional limitations including exercise
- normal lung function, minimal side effects
Pharmacological management: asthma controlled vs. uncontrolled
Controlled:
- Environment control, education, action plan
- SABA
- ICS
Uncontrolled: (Environment control, education, action plan; SABA; ICS) - LABA - LTRA, - Prednisone
