Asthma Flashcards
What are the phenotypes of asthma?
Allergic asthma
Non allergic asthma
Adult onset asthma
Asthma with persistent airflow limitation
Asthma with obesity
What are the typical features of asthma?
Wheeze, SoB, cough, chest tightness
Patients experience more than one symptoms
Symptoms often worse at night or early morning
Symptoms very over time and in intensity
Triggered by viral infections, exercise, allergen exposure, changes in weather, laughter, irritants such as car exhaust fumes, smoke and strong smells
What features reduce the possibility of asthma?
Isolated cough with no ither respiratory symptom
Chronic production of sputum
SoB associated with dizziness, light headedness or peripheral tingling
Chest pain
Exercise induces dyspnea with noisy respiration
What is the diagnostic algorithm of asthma?
Pts with respiratory symptoms
Are they typical of asthma
YES- detailed history/Examination
NO- further history and tests for alternative diagnoses
If the detailed history and ex supports asthma diagnosis
YES- Perform spirometry/ PEF with reversibility test
NO- further hx and tests for alternative dx
If spirometry and PEF supports asthma?
YES- treat for asthma
NO- repeat on another occasion or arrange other tests
If repeated tests and other tests don’t support asthma or alternative diagnosis are not entirely confirmed even after doing spirometry
Start a trial of treatment
If the pt presents in an emergency and other dx are unlikely
Treat empirically and review response and diagnostic
Testing is done within 1-3mon
What are the diagnostic criteria?
1) history of variable respiratory symptoms
2) confirmed variable expiratory airflow limitation
What are variable respiratory symptoms?
Wheeze, sob, chest tightness and cough
Generally more than one type of respiratory symptom
Symptoms occur invariably over time and vary in intensity
Sy often worse at night or on waking
Sy often triggered by exercise, laughter, allergens and cold air
Sy often appears or worsen with viral infections
How to confirm the variable expiratory airflow limitation?
1) Documented expiratory airflow limitation
When FEV1 is reduced, confirm that FEV1/FVC ratio is also reduced
Normal > 75%-80% in adults, > 90% in children
Second method?
2)Documented excessive variability in lung functions (one or more of the following)
Positive bronchodilator reversibility
Excessive variability in twice daily PEF over 2 weeks
Significant increase in lung function after 4 weeks of antiinflammatory treatment
Post exercise challenge test
Positive bronchial challenge test
Excessive variation in lung functions between visits
Positive bronchodilator reversibility test?
Increase in FEV1>12% and >200mL
(Adults)
Increase in FEV1 of >12% predicted
Change measured 10-15mins after 200-400mcg of salbutamol
Positive test more likely if BD withheld before test
SABA > 4hrs
Twice daily LABA 24 hrs
Once daily LABA 36hrs
Excessive variability in twice daily PEF?
Adults average daily diurnal PEF variability >10%
Children average daily diurnal PEF variability >13%
Treatment?
First confirm the diagnosis
Symptom control and modifiable risk factors
Comorbidities
Inhaler technique and adherence
Patient preferences and goals
Two track method?
Track 1- CONTROLLER AND PREFERRED RELIEVER
Track 2- CONTROLLER AND ALTERNATIVE RELIEVER
Describe track 1
Step 1-2 as needed low dose ICS- formoterol
(Sy less than 4-5 days a week)
Step 3 low dose maintenance ICS formoterol
(Sy most days or waking asthma once a week or more)
Step 4 medium dose maintenance ICs formoterol
(Daily sy or waking asthma once a week or more and low lung function)
Step 5 consider high dose ICS- formoterol add on LAMA
RELIEVER for every step lowdose ICS-formoterol
Describe track 2
Step 1 Take ICS whenever SABA is taken
( sy less than twice a month)
Step 2 low dose maintenance ICS
(Sy twice a month or more, but less than 4-5 days a week)
Step 3 Low dose maintenance ICS -LABA
(Sy most days or waking asthma once a week or more
Step 4 medium/high dose maintenance ICS LABA
(Daily sy or waking asthma once a week or more and low lung function)
Step 5 high dose ICS- LABA add on LAMA
RELIEVER ALWAYS as needed SABA
