Asthma and Allergies

Question 1

How can you diagnose asthma?

Answer 1

1. Wheeze is suggestive but not pathognomonic
2. Response to bronchodilator is suggestive
3. Chronic cough may be a primary manifestation
4. HISTORY

Question 2

History taking questions?

Answer 2

1. Recurrent cough or wheeze?
2. Cold that “go to the chest” or take >10 days?
3. Cough/wheeze during a particular time of the year
4. Cough/wheeze/SOB when exposed to certain things?
5. Used any medications to help you breathe better?
   - in the past 12 months
6. have you had cough, wheeze, or shortness of breath - At night?, Upon awakening?, After play?
   - in the past 4 weeks

Question 3

Common asthma triggers?

Answer 3

1. Animals
2. Cockroaches/rodents
3. Molds/dampness
4. Spring (pollen)
5. Rainy season (molds)
6. Tobacco
7. Wood-burning or paraffin stove
8. Perfumes, cleaning agents, bug spray
9. maize harvesting season

Question 4

Differential diagnosis for acute wheezing?

Answer 4

1. Asthma
2. Bronchiolitis
3. Atypical infection - causing atypical pneumonia (Myecoplasma)
4. Bacterial tracheitis
5. Foreign body
6. Anaphylaxis - associated with hives, swollen face, stridor and previous reaction to allergen

Question 5

Causes of recurrent persistent childhood wheeze?

Answer 5

1. viral episodic wheeze
2. multiple trigger wheeze
3. asthma
4. tracheo-bronchomalacia
5. bronchopulmonary dysplasia
6. recurrent anaphylaxis
7. cystic fibrosis
8. chronic aspiration
9. bronchiolitis obliterans

Question 6

Structural ddx chronic wheezing?

Answer 6

1. Tracheo-bronchomalacia
2. Vascular rings
3. Tracheal stenosis
4. Cystic masses
5. Tumors or lymphadenopathy
6. Cardiac failure

Question 7

Functional ddx chronic wheezing?

Answer 7

1. Asthma
2. Gastroesophageal reflux (GERD)
3. Recurrent aspiration (e.g CP)
4. Cystic fibrosis
5. Immunodeficiency
6. Bronchopulmonary dysplacia (ex-premie)
7. Retained foreign body
8. Bronchiolitis obliterans
9. Pulmonary oedema
10. Vocal cord dysfunction
11. Interstitial lung disease

Question 8

What are the stages of asthma?

Answer 8

1. intermittent
2. mild persistent
3. moderate persistent
4. severe persistent

Question 9

What is intermittent asthma?

Answer 9

Daytime symptoms 2 or fewer days/week
Nocturnal symptoms 2 or fewer nights/month
No interference in daily activities or play
1 or fewer exacerbations per year

Question 10

What is mild persistent asthma?

Answer 10

Daytime symptoms 3-6 days/week
Nocturnal symptoms 3-4 nights/month
Minor interference with daily activities or play
2 or more exacerbations per year

Question 11

What is moderate persistent asthma?

Answer 11

Daily symptoms
Nocturnal symptoms more than once per week
Daily inhaler use
Some activity limitation

Question 12

What is severe persistent asthma?

Answer 12

Symptoms throughout the day
Nocturnal symptoms most nights
Significant limitation in activity