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Asthma diagnosis

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Heaven Bird
Heaven Bird

This document discusses the diagnosis of asthma through various methods. It describes how peak expiratory flow rate (PEFR) and spirometry can be used to diagnose asthma. PEFR measures how fast a person can exhale and variability greater than 20% or improvement of 20% after treatment suggests asthma. Spirometry is recommended to assess reversibility, with improvement of over 15% in FEV1 after a beta-2 inhaler indicating asthma. Lung function classifications of asthma severity are provided based on symptoms and lung function tests.

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ProfessorProfessor Abdur-Rab KhanAbdur-Rab Khan MRCP- FRCP (UK)MRCP- FRCP (UK) Ayub Medical College AbbottabadAyub Medical College Abbottabad
Diagnosis of AsthmaDiagnosis of Asthma
HistoryHistory
Asthma diagnosis
Peak Expiratory Flow RatePeak Expiratory Flow Rate (PEFR)(PEFR) Measures how fast a person can exhale air Requires a peak expiratory flow monitor OmronMini-Wright AM2 Plus
PEFR VariabilityPEFR Variability Asthma Diagnostic Clues: PEF Variability > 20% (basis: home monitoring 2-4x/day for 1-2 weeks) Improvement in baseline PEF by 20% after a 2-week therapeutic trial PEFmax - PEFmin PEFave (pm, post-bd) (am, pre-bd) % Variability = X 100 0 50 100 150 200 250 300 350 1 2 3 4 5 6 7 Days PEFR(L/min) pm PEFR am PEFR
Asthma diagnosis
Asthma diagnosis
Asthma diagnosis
SpirometrySpirometry Recommended for the initial assessment of all asthma suspects!
Asthma diagnosis
Asthma diagnosis
> 15% increase in FEV1.0 after -2 inhalation Hallmark of Asthma: Reversibility! Spirometry
Asthma diagnosis
Types of Flow Volume Curves Normal Obstructive Litersper second Concavity Asthma Concavity pre- bronchodilator Improved post-bronchodilator
Good MeasurementsGood Measurements are Essential!are Essential! Acceptable Loop Unacceptable Loop
Is it Asthma? Determine that the patient is experiencing episodic symptoms of airflow obstruction Demonstrate that the obstruction is at least partially reversible Exclude alternate diagnoses
Asthma wheezing Lung Disease Overlap Chronic Bronchitis cough+sputum Emphysema breathlessness Airway Remodeling in Asthma Denudation of the airway epithelium Collagen deposition beneath the basement membrane Edema Mast cell activation Inflammatory cell infiltration COPD
Classifying Severity: BASED ON SYMPTOMS & LUNG FUNCTION Daytime Symptoms Exacerbations Night attacks 11 22 33 44 IntermittentIntermittent <1x a week Brief MildMild persistentpersistent >1x a week but < 1x/day May affect activity & sleep ModerateModerate persistentpersistent Daily May affect activity & sleep SevereSevere persistentpersistent < 2x a month > 2x a month > once a week Frequent Daily Frequent Limits physical activity FEV1 or PEF > 80% predicted Variability < 20% > 80% predicted Variability 20-30% > 60-80% predicted Variability > 30% < 60% predicted Variability > 30%
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Asthma diagnosis

  • 1. ProfessorProfessor Abdur-Rab KhanAbdur-Rab Khan MRCP- FRCP (UK)MRCP- FRCP (UK) Ayub Medical College AbbottabadAyub Medical College Abbottabad
  • 5. Peak Expiratory Flow RatePeak Expiratory Flow Rate (PEFR)(PEFR) Measures how fast a person can exhale air Requires a peak expiratory flow monitor OmronMini-Wright AM2 Plus
  • 6. PEFR VariabilityPEFR Variability Asthma Diagnostic Clues: PEF Variability > 20% (basis: home monitoring 2-4x/day for 1-2 weeks) Improvement in baseline PEF by 20% after a 2-week therapeutic trial PEFmax - PEFmin PEFave (pm, post-bd) (am, pre-bd) % Variability = X 100 0 50 100 150 200 250 300 350 1 2 3 4 5 6 7 Days PEFR(L/min) pm PEFR am PEFR
  • 10. SpirometrySpirometry Recommended for the initial assessment of all asthma suspects!
  • 13. > 15% increase in FEV1.0 after -2 inhalation Hallmark of Asthma: Reversibility! Spirometry
  • 15. Types of Flow Volume Curves Normal Obstructive Litersper second Concavity Asthma Concavity pre- bronchodilator Improved post-bronchodilator
  • 16. Good MeasurementsGood Measurements are Essential!are Essential! Acceptable Loop Unacceptable Loop
  • 17. Is it Asthma? Determine that the patient is experiencing episodic symptoms of airflow obstruction Demonstrate that the obstruction is at least partially reversible Exclude alternate diagnoses
  • 18. Asthma wheezing Lung Disease Overlap Chronic Bronchitis cough+sputum Emphysema breathlessness Airway Remodeling in Asthma Denudation of the airway epithelium Collagen deposition beneath the basement membrane Edema Mast cell activation Inflammatory cell infiltration COPD
  • 19. Classifying Severity: BASED ON SYMPTOMS & LUNG FUNCTION Daytime Symptoms Exacerbations Night attacks 11 22 33 44 IntermittentIntermittent <1x a week Brief MildMild persistentpersistent >1x a week but < 1x/day May affect activity & sleep ModerateModerate persistentpersistent Daily May affect activity & sleep SevereSevere persistentpersistent < 2x a month > 2x a month > once a week Frequent Daily Frequent Limits physical activity FEV1 or PEF > 80% predicted Variability < 20% > 80% predicted Variability 20-30% > 60-80% predicted Variability > 30% < 60% predicted Variability > 30%

Editor's Notes

  1. 06/15/13
  2. 06/15/13
  3. 06/15/13
  4. 06/15/13 Self explanatory.
  5. 06/15/13