Asthma diagnosis

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  • 1. ProfessorProfessorAbdur-Rab KhanAbdur-Rab KhanMRCP- FRCP (UK)MRCP- FRCP (UK)Ayub Medical College AbbottabadAyub Medical College Abbottabad

2. Diagnosis of AsthmaDiagnosis of Asthma 3. HistoryHistory 4. Peak Expiratory Flow RatePeak Expiratory Flow Rate(PEFR)(PEFR) Measures how fast a person can exhale air Requires a peak expiratory flow monitorOmronMini-Wright AM2 Plus 5. PEFR VariabilityPEFR VariabilityAsthma Diagnostic Clues: PEF Variability > 20%(basis: home monitoring 2-4x/dayfor 1-2 weeks) Improvement in baseline PEF by20% after a 2-week therapeutictrialPEFmax - PEFminPEFave(pm, post-bd) (am, pre-bd)% Variability = X 1000501001502002503003501 2 3 4 5 6 7DaysPEFR(L/min)pm PEFRam PEFR 6. SpirometrySpirometry Recommended for the initial assessment of allasthma suspects! 7. > 15% increase in FEV1.0after -2 inhalationHallmark of Asthma: Reversibility!Spirometry 8. Types of FlowVolume CurvesNormal ObstructiveLiterspersecondConcavityAsthmaConcavitypre-bronchodilatorImprovedpost-bronchodilator 9. Good MeasurementsGood Measurementsare Essential!are Essential!AcceptableLoopUnacceptableLoop 10. Is it Asthma?Determine that the patient isexperiencing episodic symptomsof airflow obstructionDemonstrate that theobstruction is at least partiallyreversibleExclude alternate diagnoses 11. AsthmawheezingLung Disease OverlapChronicBronchitiscough+sputumEmphysemabreathlessnessAirway Remodeling inAsthmaDenudation of the airwayepitheliumCollagen depositionbeneath the basementmembraneEdemaMast cell activationInflammatory cellinfiltrationCOPD 12. Classifying Severity:BASED ON SYMPTOMS & LUNG FUNCTIONDaytimeSymptomsExacerbations Nightattacks11223344IntermittentIntermittent 1x a weekbut < 1x/day May affectactivity &sleepModerateModeratepersistentpersistent Daily May affectactivity &sleepSevereSeverepersistentpersistent < 2x amonth > 2x amonth > oncea week Frequent Daily Frequent LimitsphysicalactivityFEV1 or PEF > 80% predicted Variability < 20% > 80% predicted Variability 20-30% > 60-80%predicted Variability > 30% < 60% predicted Variability > 30% 13. THANK YOUTHANK YOU