Asthma Diagnosis Flashcards
Symptoms of asthma
Wheeze
Sob
Tightness
Cough which vary
Reversible is lost during
Exacerbation
Viral infection
Long standing asthma
Diagnostic criteria of asthma
Symptoms
Documented variable exporatory airflow
Positive bd reversiblity
Adults
Children
12 and 200
Greater confidence if 15 and 400
Children 12
What is excessive variability in pef
Adults 10
Children 13
What is significant increase in lung function after using ics for 4 weeks
Same as bd
Pefr 20 from baseline
Criteria for positive exercise challenge test
Fall in 10 or 200ml
Child- 12
Methacholime criteria
Hyperventilation/mannitol
Fev1 20
15
Excessive variation between visits
Same as bd
What to ask in history
Atopic
Eczema
Allergies
Asthma history
Physical exam if asthma
Expiratory wheeze on forced exp
Silent chest
Conditions where methacholine test positive
Copd
Cf
Allergic rhinitis
Other tests to diagnose asthma
Feno
Allergy tests- skin pick, ige
If already on controller treatment
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
Assess
Adjust
Review for step down
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
Differentiate cva and eosinophilic bronchitis
Pft abnormality in cvasthma
Eosinophilia in both
Definition of asthma
Heterogenous disease charac by chronic airway inflammation, defined by h/o symptoms , with variable Expiratory airflow limitation
5 phenotypes
Allergic Non Allergic Adult onset- rule out occupational Persistent airflow limitation Obesity
How do u assess control
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
How do u assess severity
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
Control
Partly1-2
Uncontrolled 3-4
Last 4 weeks Symptoms day/ week >2/week Any night waking Limitation of activity Frequency of saba >2 /week 1point for each
R/f for exacerbation
3 cannisters/yr Comorbidities Fev1 60 High feno/e Independent- h/o intubation, >1 severe exacerbation
Role of spirometry
Diagnosis
Base line fev1
Response
If there is excessive variation on ics
Poor control
Risk of exacerbation
Reaches plateau in 2 months
How do u investigate a patient having poor control
Technique Confirm diagnosis Remove r/f , Comorbidities Step up Consider other diagnosis
Criteria for mild/ moderate exacerbation
Rx
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
Criteria for severe/life threatening
Words/ agitated/accessory muscle use/<90 spo2
Threatening- drowsy /confuse/silent chest
Criteria for discharge
Pef increased to 60-80
O2>94
Steroid for week
Continue reliever
Criteria for admission
Pre treatment fev1 <25 Post treatment fec1<40 Older >8 saba in 24 hrs Severe exacerbation now or In past
When will u use ics in copd
Eosinophilia more than 300
More than 2 exacerbations per year needing ocs
What is asthma / copd overlap
Term collectively used to describe pts who have persistent airflow limitation together with clinical features of both
How do u differentiate asthma from copd
Dlco Abg Hrct- asthma- bw thickening, trapping Copd- phtn/airtrapping/emphysema Fenix Ige
