Asthma Flashcards
Normal spirometry does not exclude asthma
Common reasons for lack of reversibility
Baseline FEV1 is normal
Recent use of a bronchodilator
Airway inflammation & oedema (poorly controlled asthma) – reversibility may return after treatment
Asthma is a disease of the airways characterised by:
- Variable airflow obstruction
- Bronchial hyper-responsiveness
- Airway inflammation
use of peak flow monitoring in asthma diagnosis
A period of peak flow monitoring (2 weeks at least) can be very useful if the diagnosis is uncertain or if occupational asthma is suspected (PEF low in certain places/ scenarios)
When is laboratory confirmation of bronchial hyper-responsiveness used?
Only occasionally needed where clinical features are atypical or where the diagnosis has important implications (defence force employment)
Unnecessary if clinical features and treatment response are typical of asthma
Unnecessary if variable airflow obstruction has already been documented
Can be hazardous in setting of poorly controlled asthma or severe airflow obstruction
Use of Exhaled nitric oxide testing
marker of allergic inflammation, steroid responsiveness
Use of blood eosinophil count
if >0.3 x 10 9per litre, airway eosinophilia is likely
Samter’s triad
Asthma, aspirin intolerance, nasal polyps
“Aspirin-exacerbated respiratory disease”
ABPA clinically (and Ix)
Chronic asthma, recurrent pulmonary infiltrates, bronchiectasis
Very high total IgE (>1000 IU/mL)
Evidence of Aspergillus sensitivity
EGPA clinically
Necrotising Vasculitis, granulomas, tissue eosinophilia
Asthma + blood eosinophilia essential
Cardiac disease accounts for 50% of deaths
STEP 1 in asthma management 2019 GINA guidelines
PRN Low dose ICS-formeterol
OR
SABA + ICS
STEP 2 in asthma management 2019 GINA guidelines
Regular LOW dose ICS-formeterol (plus PRN)
OR
Regular low dose ICS
Consider montelukast
STEP 3 in asthma management 2019 GINA guidelines
Daily LOW dose ICS-formeterol (plus PRN)
OR consider
Medium Dose ICS
Consider montelukast (w low dose ICS)
STEP 4 in asthma management 2019 GINA guidelines
Daily MEDIUM dose ICS-formeterol (plus PRN)
consider
- add on tiotropium
- montelukast
- high dose ICS
STEP 5 in asthma management 2019 GINA guidelines
Daily HIGH dose ICS-formeterol (plus PRN)
AND
Phenotypic assessment + immunological
consider
- OCSs
place for long term oral steroids in asthma
Adrenal insufficiency
Asthma variants
* Allergic bronchopulmonary aspergillosis (induction therapy)
* Eosinophilic granulomatosis with polyangiitis (EGPA)