Asthma Diagnosis

Question 1

Symptoms of asthma

Answer 1

Wheeze
Sob
Tightness
Cough which vary

Question 2

Reversible is lost during

Answer 2

Exacerbation
Viral infection
Long standing asthma

Question 3

Diagnostic criteria of asthma

Answer 3

Symptoms

Documented variable exporatory airflow

Question 4

Positive bd reversiblity
Adults
Children

Answer 4

12 and 200
Greater confidence if 15 and 400
Children 12

Question 5

What is excessive variability in pef

Answer 5

Adults 10

Children 13

Question 6

What is significant increase in lung function after using ics for 4 weeks

Answer 6

Same as bd

Pefr 20 from baseline

Question 7

Criteria for positive exercise challenge test

Answer 7

Fall in 10 or 200ml

Child- 12

Question 8

Methacholime criteria

Hyperventilation/mannitol

Answer 8

Fev1 20

15

Question 9

Excessive variation between visits

Answer 9

Same as bd

Question 10

What to ask in history

Answer 10

Atopic
Eczema
Allergies
Asthma history

Question 11

Physical exam if asthma

Answer 11

Expiratory wheeze on forced exp

Silent chest

Question 12

Conditions where methacholine test positive

Answer 12

Copd
Cf
Allergic rhinitis

Question 13

Other tests to diagnose asthma

Answer 13

Feno

Allergy tests- skin pick, ige

Question 14

If already on controller treatment

Answer 14

Variable symptoms n AL - CONFIRM
if symp plus and no AL limitation- more than 70 - step down
If <70 - step up for 3 mon
If few symp , no AL - WITHHOLD
Of symp emerge- asthma
If no - stop and followup

Question 15

Assess
Adjust
Review for step down

Answer 15

If r/f for exacerbation plus don’t stop
Suitable time, Give plan
Adjust- how to dec , stop extra controller
Review after 2- 4 wks with spiro

Question 16

Differentiate cva and eosinophilic bronchitis

Answer 16

Pft abnormality in cvasthma

Eosinophilia in both

Question 17

Definition of asthma

Answer 17

Heterogenous disease charac by chronic airway inflammation, defined by h/o symptoms , with variable Expiratory airflow limitation

Question 18

5 phenotypes

Answer 18

Allergic
Non Allergic
Adult onset- rule out occupational 
Persistent airflow limitation
Obesity

Question 19

How do u assess control

Answer 19

Extent to which features of asthma removed by rx
Freq of day and night time symptoms 
Night time waking
Use if frequency of saba
Asthma control test/ questionnaire

Question 20

How do u assess severity

Answer 20

Retrospective - atleast after 2- 3mon of controller
Severe asthma- ics+laba high dose or need of biologicals
Moderate- well controlled on step 3 or 4
Mild- with sos laba+ics

Question 21

Control
Partly1-2
Uncontrolled 3-4

Answer 21

Last 4 weeks
Symptoms day/ week >2/week
Any night waking
Limitation of activity
Frequency of saba >2 /week
1point for each

Question 22

R/f for exacerbation

Answer 22

3 cannisters/yr 
Comorbidities
Fev1 60
High feno/e
Independent- h/o intubation,  >1 severe exacerbation

Question 23

Role of spirometry

Answer 23

Diagnosis
Base line fev1
Response

Question 24

If there is excessive variation on ics

Answer 24

Poor control
Risk of exacerbation
Reaches plateau in 2 months

Question 25

How do u investigate a patient having poor control

Answer 25

``` Technique Confirm diagnosis Remove r/f , Comorbidities Step up Consider other diagnosis ```

Question 26

Criteria for mild/ moderate exacerbation | Rx

Answer 26

``` Phrases No accessory muscles 90-95 on ra Pef >50 Saba4-10 puff rpt 20 min for 1hr Pred 40- 50 mi Oxygen Assess- if improve discharge ```

Question 27

Criteria for severe/life threatening

Answer 27

Words/ agitated/accessory muscle use/<90 spo2 | Threatening- drowsy /confuse/silent chest

Question 28

Criteria for discharge

Answer 28

Pef increased to 60-80 O2>94 Steroid for week Continue reliever

Question 29

Criteria for admission

Answer 29

``` Pre treatment fev1 <25 Post treatment fec1<40 Older >8 saba in 24 hrs Severe exacerbation now or In past ```

Question 30

When will u use ics in copd

Answer 30

Eosinophilia more than 300 | More than 2 exacerbations per year needing ocs

Question 31

What is asthma / copd overlap

Answer 31

Term collectively used to describe pts who have persistent airflow limitation together with clinical features of both

Question 32

How do u differentiate asthma from copd

Answer 32

``` Dlco Abg Hrct- asthma- bw thickening, trapping Copd- phtn/airtrapping/emphysema Fenix Ige ```