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asthma > Asthma Diagnosis > Flashcards

Asthma Diagnosis Flashcards

1
Q

Symptoms of asthma

A

Wheeze
Sob
Tightness
Cough which vary

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2
Q

Reversible is lost during

A

Exacerbation
Viral infection
Long standing asthma

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3
Q

Diagnostic criteria of asthma

A

Symptoms

Documented variable exporatory airflow

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4
Q

Positive bd reversiblity
Adults
Children

A

12 and 200
Greater confidence if 15 and 400
Children 12

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5
Q

What is excessive variability in pef

A

Adults 10

Children 13

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6
Q

What is significant increase in lung function after using ics for 4 weeks

A

Same as bd

Pefr 20 from baseline

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7
Q

Criteria for positive exercise challenge test

A

Fall in 10 or 200ml

Child- 12

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8
Q

Methacholime criteria

Hyperventilation/mannitol

A

Fev1 20

15

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9
Q

Excessive variation between visits

A

Same as bd

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10
Q

What to ask in history

A

Atopic
Eczema
Allergies
Asthma history

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11
Q

Physical exam if asthma

A

Expiratory wheeze on forced exp

Silent chest

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12
Q

Conditions where methacholine test positive

A

Copd
Cf
Allergic rhinitis

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13
Q

Other tests to diagnose asthma

A

Feno

Allergy tests- skin pick, ige

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14
Q

If already on controller treatment

A 
Variable symptoms n AL - CONFIRM
if symp plus and no AL limitation- more than 70 - step down
If <70 - step up for 3 mon
If few symp , no AL - WITHHOLD
Of symp emerge- asthma
If no - stop and followup
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15
Q

Assess
Adjust
Review for step down

A

If r/f for exacerbation plus don’t stop
Suitable time, Give plan
Adjust- how to dec , stop extra controller
Review after 2- 4 wks with spiro

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16
Q

Differentiate cva and eosinophilic bronchitis

A

Pft abnormality in cvasthma

Eosinophilia in both

17
Q

Definition of asthma

A

Heterogenous disease charac by chronic airway inflammation, defined by h/o symptoms , with variable Expiratory airflow limitation

18
Q

5 phenotypes

A 
Allergic
Non Allergic
Adult onset- rule out occupational 
Persistent airflow limitation
Obesity
19
Q

How do u assess control

A 
Extent to which features of asthma removed by rx
Freq of day and night time symptoms 
Night time waking
Use if frequency of saba
Asthma control test/ questionnaire
20
Q

How do u assess severity

A

Retrospective - atleast after 2- 3mon of controller
Severe asthma- ics+laba high dose or need of biologicals
Moderate- well controlled on step 3 or 4
Mild- with sos laba+ics

21
Q

Control
Partly1-2
Uncontrolled 3-4

A 
Last 4 weeks
Symptoms day/ week >2/week
Any night waking
Limitation of activity
Frequency of saba >2 /week
1point for each
22
Q

R/f for exacerbation

A 
3 cannisters/yr 
Comorbidities
Fev1 60
High feno/e
Independent- h/o intubation,  >1 severe exacerbation
23
Q

Role of spirometry

A

Diagnosis
Base line fev1
Response

24
Q

If there is excessive variation on ics

A

Poor control
Risk of exacerbation
Reaches plateau in 2 months

25
Q

How do u investigate a patient having poor control

A 
Technique
Confirm diagnosis 
Remove r/f , Comorbidities
Step up
Consider other diagnosis
26
Q

Criteria for mild/ moderate exacerbation

Rx

A 
Phrases
No accessory muscles
90-95 on ra
Pef >50
Saba4-10 puff rpt 20 min for 1hr
Pred 40- 50 mi
Oxygen
Assess- if improve discharge
27
Q

Criteria for severe/life threatening

A

Words/ agitated/accessory muscle use/<90 spo2

Threatening- drowsy /confuse/silent chest

28
Q

Criteria for discharge

A

Pef increased to 60-80
O2>94
Steroid for week
Continue reliever

29
Q

Criteria for admission

A 
Pre treatment fev1 <25
Post treatment fec1<40
Older
>8 saba in 24 hrs
Severe exacerbation now or In past
30
Q

When will u use ics in copd

A

Eosinophilia more than 300

More than 2 exacerbations per year needing ocs

31
Q

What is asthma / copd overlap

A

Term collectively used to describe pts who have persistent airflow limitation together with clinical features of both

32
Q

How do u differentiate asthma from copd

A 
Dlco
Abg
Hrct- asthma- bw thickening,  trapping
Copd- phtn/airtrapping/emphysema
Fenix
Ige

asthma (3 decks)

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