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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
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
SpirometrySpirometry
 Recommended for the initial assessment of all
asthma suspects!
> 15% increase in FEV1.0
after ß-2 inhalation
Hallmark of Asthma: Reversibility!
Spirometry
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%
THANK YOUTHANK YOU

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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
  • 4.
  • 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
  • 7.
  • 8.
  • 9.
  • 10. SpirometrySpirometry  Recommended for the initial assessment of all asthma suspects!
  • 11.
  • 12.
  • 13. > 15% increase in FEV1.0 after ß-2 inhalation Hallmark of Asthma: Reversibility! Spirometry
  • 14.
  • 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%

Notas do Editor

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