Respiratory Flashcards
Asthma diagnosis <6 years old
- Patient + family hx
- Exlcude other pathology if refractory to tx
- Require all 3 of the following documented during >/ 2 episodes: airflow obstruction (cough/difficulty breathing/wheeze), reversibility of airflow obstructions (improvement with SABA +/- oral steroids), no clinical evidence of alternate diagnosis.
Asthma diagnosis >/ 6 years old
- Patient + family hx
- Spirometry or positive methacholine or exercise challenge test or sufficient peak exp flow variability
- Assess for signs of atopy which predicts persistent asthma
What to discontinue before spirometry and for how long
ICS +/- LABA 24 hours prior
Spirometry asthma diagnosis for children >6 years old
FEV1/FVC < 0.8 - 0.9 AND increase in FEV1 12% with bronchodilator
Spirometry asthma diagnosis for adults
FEV1/FVC < 0.75 - 0.8 AND increase in FEV1 12% (>200ml) with bronchodilator
PEF asthma diagnosis for children >6 years old
Increase >/ 20% with bronchodilator
PEF asthma diagnosis for adults
Increase more than 60L/min (min 20%) with bronchodilator
Dinural variation > 8-10% measured BID
Methacholine challenge diagnosis for asthma
PC20 <4mg/mL (4-16 borderline, >16 negative)
Exercise challenge diagnosis for asthma
FEV1 decrease more than 10-15% post exercise
Good asthma control - freq of daytime symptoms
<2 days / week
Good asthma control - freq of nightime symptoms
<1 night / week and mild
Good asthma control - symptoms with exercise
Normal
Good asthma control - freq of exacerbations
Mild, infrequent
(Mild: increase in symptoms not req systemic steroids or hospitalisation)
Good asthma control - freq of absence from work or school
None
Good asthma control - freq of need for Ventolin
</2 a week