Patient examination Flashcards
What factors lead to an asthma diagnosis?
Presence of >1
- Wheeze
- Cough
- Chest tightness
- Breathlessness
- symptom variability
- diurnal
- recurrent attacks
- observing wheeze
- variation in air flow
- atopic history
- no other diagnosis
What are some triggers of asthma?
- hormones
- exercise
- cold air
- dust
- pollution
- pets
- cigarette smoke
- cold/flu
- stress
What is the optimal aim of asthma treatment?
- minimum side effects (min necessary dose)
- No daytime symptoms
- No rescue medications
- No night waking
- No attacks
- Unlimited ADL and exercise
- FEV1/PEF> 80%
What are some occupational exposures which could affect asthma?
- baking
- spray painting
- lab animal work
- healthcare/dental care
- food processing
- welding/soldering
- metalwork
- Woodwork
- chemical processing
- farming
- textiles/rubber
What are the three main purposes of history taking?
- Diagnosis
- Management plan
- Lifetsyle modification
What are the main things to be included in a patient history?
- Name
- Gender
- DOB
- History/presenting complaint
- Past medical history
- Medications: dose, alternative therapies
- Drug allergies
- Family history: 1st degree relatives
- Social history: smoking, alcohol, occupation, exercise
What is the tailored patient history to asthma?
- History presenting complaint: current symptoms (e.g.cough), diurnal variation?, exacerbating/relieving factors, episodic attacks (frequency and timing), number of illnesses in last year (e.g. A&E admission), response to URTIs
- Past history: allergies, hayfever, nasal polyps
- Medications: beta blockers, NSAIDS
- Family history: asthma/allergies/eczema
- Social history: smoke exposure?, pets, smoking history, occupation, work, family
What should people with asthma keep with them and have updated yearly?
Asthma action plan- has details of what to do when asthma is under control or during an attack. Also has information on triggers and healthcare provider numbers.
What are the main points covered in an asthma review?
- asthma control: frequency of attacks, symptoms over last month, inhaler use
- adherence to medication
- inhaler technique
- lung function assessment
- education: trigger awareness and avoidance, stop smoking, weight control/exercise
- annual asthma plan
What happens after an asthma review?
The patient is assessed and based on how their asthma is controlled, they may be moved down to a lower-dose inhaler (ICS- inhaled corticosteroids) or moved up to additional therapies or increasing the dosage
