Asthma

Question 1

What is Asthma?

Answer 1

BTS guidelines advised that the Diagnosis of asthma is based on the recognition of a characteristic pattern of symptoms & signs and the absence of an alternative explanation for them. However, in response to a series of concerns about both over- diagnosis and under-diagnosis of asthma.

Current NICE asthma guidelines advises ‘not to use symptoms alone without any objective test to diagnose asthma nor to use a history of atopic disorders alone to diagnose asthma.;

In terms of investigating adults, NICE advises to measure fractional exhaled nitric oxide (FENO) first followed by spirometry and then to carry out bronchodilators reversibility test if spirometry shows an obstruction.

Question 2

What is the initial diagnosis for Asthma?

Answer 2

It is based on a careful assessment of symptoms and a measure of airflow obstruction.

Question 3

What clinical features that INCREASE the probability of asthma?

Answer 3

• > 1 of the following symptoms:
• Wheeze, breathlessness, chest tightness & cough, particularly if:
  1. Symptoms worse at night & in the early morning
  2. Symptoms in response to exercise, allergen exposure & cold air
  3. Symptoms after taking aspirin or beta blockers.
• History of atopic disorder
• Family history of asthma & atopic disorder
• widespread wheeze heard on auscultation of the chest
• otherwise unexplained low FEV1 or PEF (historical or serial readings)
• Otherwise unexplained peripheral blood eosinophilia

Question 4

What clinical features that DECREASE the probability of asthma?

Answer 4

• Prominent dizziness, light - headedness, peripheral tingling
• Chronic productive cough in the absence of wheeze or breathlessness
• Repeatedly normal physical examination of chest when symptomatic
  *Voice disturbance
  *Symptoms with colds only
  *Significant smoking history ( i.e >20 pack years)
  *Cardiac disease
• Normal PEF or spirometry when symptomatic