Asthma

Question 1

Useful tests

Answer 1

Spirometry
Peak flow variability
Bronchoprovocation testing

Question 2

Diagnosis

Answer 2

Spirometry - An increase in FEV1 of 12% with a min increase of 200 ml in FEV1 after bronchodilator use establishes the presence of airflow reversibility and the diagnosis of asthma
Bronchoprovocation testing - the lower the concentration of inhaled methacholine needed to cause a 20% drop in FEV1, the more likely the patient has asthma (high sensitivity, high negative predictive value

Question 3

Treatment

Answer 3

1. short-acting B-agonists - albuterol (salbutemol)
2. when (1) is needed for:
   - symptom relief > 2x wk for daytime symptoms/
   - 2x mon for night-time awakenings –> long-acting controller medication is indicated

Question 4

Mild persistent disease

Answer 4

Dx: symptoms > 2 days/week, > 2x month nighttime awakenings
Tx: albuterol (SABA) + low dose inhaled corticosteroid

Question 5

Moderate persistent disease

Answer 5

Dx: daily symptoms, > 1 x week but not nightly awakenings
Tx: long-acting B-agonist + low dose inhaled corticosteroid

Question 6

Severe persistent disease

Answer 6

Dx: symptoms throughout the day, often 7x week nighttime awakenings
Tx: 3 meds - high doses of inhaled corticosteroids + long-acting bronchodilator + possibly oral corticosteroids
+/- leukotriene modifier

Question 7

Intermittent disease

Answer 7

Dx: < 2 days/week symptoms, < 2 xmon nighttime awakenings
Tx: SABA

Question 8

Exercise induced asthma (bronchospasms)

Answer 8

Dx: exercise testing with post exercise spirometry
Tx: prophylactic use of medium-acting inhaled B2 agonist 5 - 10 min before exercise