diagnosis workshop W1

Question 1

is the characterstic smoker/ex-smoker ashma or COPD

Answer 1

astma possible

COPD nearly all

Question 2

is the characterstic symptoms under 35yrs ashma or COPD

Answer 2

asnthma common

COP rare

Question 3

is the characterstic chronic productive cough ashma or COPD

Answer 3

asmtha uncommon

COPD common

Question 4

is the characterstic breathlessness ashma or COPD

Answer 4

ashma variable

COPD persistnet and progessive

Question 5

is the characterstic night time symptoms ashma or COPD

Answer 5

asthma common

COPD uncommon

Question 6

is the characterstic significant diurnal variation or variation da to day ashma or COPD

Answer 6

asmtha common

COPD uncommon

Question 7

asthma signs and symptoms

Answer 7

Episodic
◦ Wheeze
◦ Chest tightness
◦ Breathlessness
◦ Cough
Diurnal variation Atopic history
Absence of signs/symptoms to suggest alternative diagnosis

Triggers
◦ Allergen exposure
◦ Infection
◦ Exercise
◦ Cold air
◦ Emotion
◦ Medication

Question 8

high ashtma diagnosis probability

Answer 8

• Typical symptoms
• Recurrent episodes
• Wheeze
• Record of variability
• Atopy
• No suggestion of alternative

Record likely asthma
Start treatment – 6 weeks ICS Reassess symptoms
FEV1/PEF Diagnosis confirmed

Question 9

intermediate asthma diagnosis probability

Answer 9

• Some but not all typical features
• Do not respond to initial treatment

Spirometry with bronchodilator reversibility test
Repeat tests following ICS treatment

Question 10

intermediate asthma diagnosis probability

Answer 10

• No typical symptoms
• Alternative diagnosis probable

investiagate further

Question 11

peak flow

Answer 11

Measurement of volume of air expelled from lungs
Cheap and easy to use
Keep diary
Useful for diagnosis and monitoring

Question 12

asthma diagnosis red flags

Answer 12

Prominent systemic features
Unexpected clinical features – including crackles, stridor, cyanosis, abnormal voice
Persistent breathlessness
Chronic sputum production
X-Ray shows shadows

Question 13

COPD diagnosis

Answer 13

Over 35 with risk factor (usually history of smoking) with 1 or more:
 Exertional breathlessness
 Chronic cough
 Regular sputum production
 Frequent winter bronchitis
 Wheeze

Has patient experienced?:
 Weight loss
 Reduced ability to exercise
 Waking due to breathlessness
 Ankle swelling
 Fatigue
 Chest pain*
 Haemoptysis*
*COPD unlikely

Question 14

Medicines Research Council (MRC) Dyspnoea scale

Answer 14

Grade - Degree of breathlessness related to activities

1 - Not troubled by breathlessness except on strenuous exercise

2 - Short of breath when hurrying or walking up a slight hill

3 - Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace

4 - Stops for breath after walking about 100 metres or after a few minutes on level ground

5 - Too breathless to leave the house, or breathless when dressing or undressing

Question 15

spirometry

Answer 15

Monitors lung function and diagnoses respiratory conditions
Measures air expelled from lungs
Reversibility testing – given bronchodilator to see if opens airways
Obstruction evident in COPD/asthma

Question 16

spirometry results

Answer 16

stage 1 (mild) - post bronchodilator <0.7, >80%FEV1

stage 2 (moderate) - post bronchodilator <0.7, 50-79%FEV1

stage 3 (severe) - post bronchodilator <0.7, 30-49%FEV1

stage 4 (very severe) - post bronchodilator <0.7, <30%FEV1