asthma diagnosis
TRANSCRIPT
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ProfessorProfessor
Abdur-Rab Khan Abdur-Rab Khan MRCP- FRCP MRCP- FRCP (UK)(UK)
Ayub Medical College AbbottabadAyub Medical College Abbottabad
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Diagnosis of AsthmaDiagnosis of Asthma
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HistoryHistory
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Peak Expiratory Flow Rate Peak Expiratory Flow Rate (PEFR)(PEFR)
Measures how fast a person can exhale air
Requires a peak expiratory flow monitor
OmronMini-Wright AM2 Plus
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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 7Days
PE
FR
(L
/min
)
pm PEFR
am PEFR
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SpirometrySpirometry Recommended for the initial assessment of all
asthma suspects!
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> 15% increase in FEV1.0
after ß-2 inhalation
Hallmark of Asthma: Reversibility!
Spirometry
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Types of Flow Volume Curves
Normal Obstructive
Lit
ers
per
se
co
nd
Concavity
Asthma
Concavitypre-
bronchodilator
Improvedpost-bronchodilator
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Good Measurements Good Measurements are Essential!are Essential!
Acceptable Loop
Unacceptable Loop
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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
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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
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Classifying Severity: BASED ON SYMPTOMS & LUNG FUNCTION
DaytimeSymptoms
Exacerbations Nightattacks
11
22
33
44
IntermittentIntermittent• <1x a week • Brief
MildMildpersistentpersistent
• >1x a week but < 1x/day
• May affect activity & sleep
ModerateModeratepersistentpersistent
• Daily • May affect activity & sleep
SevereSeverepersistentpersistent
• < 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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THANK YOU THANK YOU