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What is asthma? It is airway inflammation, airway hyper-responsiveness and variable lower airway obstruction.
Diagnosis of asthma symptoms
- Shortness of breath
- Chest tightness.
- Isolated cough
- Chronic sputum
- SOB with associated
- Exercise-induced respiratory symptoms (EIS) with noisy inspiration.
The patient’s history will look at personal atopy and family history atopy.
The physical exam:
- May be normal
- May hear wheezing
- May hear crackles
- Should include a nasal exam.
Variable airflow expiratory obstruction measures:
- Peak expiratory flow
- Forced expiratory volume in 1 second (FEV1).
Why the fuss about diagnosing asthma? You need to rule out:
- Inhaled foreign body
- Primary ciliary dyskinesia
- Congenital heart disease
- Bronchopulmonary dysplasia
- Cystic fibrosis
- Chronic upper airway cough syndrome
- HIV-associated lung disease.
How to assess your patient with asthma?
- Asthma symptom control and risk of adverse outcomes
- Assess co-morbidities.
Assessment of asthma control
Find out about daytime symptoms, night-time symptoms, activity limitation, and short acting beta-agonist (SABA) use.
Risk factors for poor asthma outcomes:
- Uncontrolled asthma symptoms
- Potentially modifiable risk factors:
- Other medical conditions
- Lung functions
- Previous intubation or ICU admission for asthma
- >1 severe exacerbation in the last 12 months.
Two major treatment factors include inhaler technique and adherence. Comorbidities include allergic rhinitis, eczema, food allergy and obesity.
What should you do before initiating controller therapy? We need to assess what is the evidence for the diagnosis of asthma. What is the child’s level of symptom control and risk factors? Any patient factors to consider? Educate the patient on inhaler technique, adherence, and emergency therapy plan. Make sure to schedule a follow-up.
- The diagnosis of asthma may be complex
- Do the basics at every visit:
- Technique and spacer use
- Emergency asthma plan
- What has the control been in the past three months?
- Stepwise escalation
- De-escalate if well controlled for three months.