71R. Primary care. Diagnosis/management of asthma Flashcards
what is asthma
chronic inflammatory airway disease
is asthma due to obstruction or restriction and hyperresponsiveness or hyporesponsiveness
obstruction and hyperresposiveness
what are clinical presentations of asthma
wheeze
SOB
chest tightness
cough - worsens at night or in the morning
what triggers asthma
allergens, exercise, infections, cold air, occupational exposure
what would you do to diagnose asthma
history taking, physical examination and diagnostic tests
what are you looking for in a history that would allude asthma
- triggers
- response to SABAs
-family history - atopy
- smoker
- occupational exposure
what are you looking for in a physical examination that would allude asthma
- expiratory wheeze
- hyperinflated chest in severe cases
- absence of wheeze does not exclude asthma
- prolonged expiratory phase
what diagnostic tests would you do for asthma
elevated eosinophils
reversible airflow obstruction
spirometry
peak expiratory flow
fractional exhaled nitric oxide (FeNO) testing
which diagnostic test is gold standard
spirometry
describe what is meant by the diagnostic tool of Reversible Airflow Obstruction
Airflow obstruction that can be reversed with medication.
Test: Spirometry before and after administering a bronchodilator (like albuterol).
Asthma Indication: If the forced expiratory volume in one second (FEV1) improves by more than 12% and 200 mL after using a bronchodilator, it suggests reversible airflow obstruction, a key feature of asthma
explain spirometry
A lung function test that measures how much air you can inhale and exhale, and how quickly you can exhale.
Test: You breathe into a spirometer, which records the amount and rate of air you breathe in and out.
Asthma Indication: An FEV1/FVC ratio (forced expiratory volume in one second/forced vital capacity) of less than 70% suggests obstructive lung disease, such as asthma
explain Peak expiratory flow
Measures the highest speed at which you can blow air out of your lungs.
Test: Using a peak flow meter, you blow into the device as hard and fast as possible.
Asthma Indication: Variability in peak flow readings of more than 20% over time suggests asthma. This test is often used for monitoring rather than diagnosis
explain FeNO testing
Measures the level of nitric oxide in your breath, which is a marker of inflammation in the airways.
Test: You exhale into a device that measures the concentration of nitric oxide.
Asthma Indication: A FeNO level greater than 50 parts per billion (ppb) suggests eosinophilic inflammation, which is common in asthma
in asthma management, what do you never give them alone
a SABA
what do you give asthmatics
start with corticoid inhaled steroid to reduce inflammation
describe the steps in managing asthmatic patients
- low dose MART (maintenance and reliever therapy) with a combination inhaler like Symbicort
- further uncontrolled - increase dose of inhaler
- even worse- referral and further tests
what is Symbicort
MART - combination of an ICS and LABA
what tests do you do to moniter asthma
eosinophil levels
FeNO test
some existing patients are just on a SABA. what should you do?
consider switching them (opportunistic switching)
