CC March 2017 Asthma diagnosis

echoecho's version from 2018-04-20 04:15


Question Answer
Define asthma?chronic pulmonary disease characterize by chronic airway inflammation and variable airway obstruction that may be reversible to some degree
Symptoms?wheezing, shortness of breath, chest tightness and/or cough
Can there be a family hx of asthma or other atopic diseases (eczema, allergic rhinitis)?yes
List the triggers for asthma flares?1) upper and lower respiratory infections 2) cold weather 3) pollen 4) tobacco smoke 5) dust 6) pet dander
Once thought to be a homogenous condition, asthma is now recognized as having several subsets, name these?1) allergic asthma 2) nonallergic asthma 3) late-onset asthma 4) asthma with fixed airflow limitation 5) asthma with obesity
Do each of these subsets have their own therapeutic implications?yes
List the characteristics that decrease the likelihood of asthma?1) isolated cough with no respiratory syptoms 2) chronic sputum production 3) shortness of breath that is associated with dizziness, lightheadedness, or parethesias 4) chest pain 5) exercise-induced dyspnea characterized by noisy inspiration
According to the Global Initiative for Asthma guidelines, pts suspected of having asthma based upon symptoms should have confirmation of variable ______airflow limitations?espiratory
How can the above be accomplished? by either spirometry OR peak expiratory flow (PEF) measurements
How is airflow obstruction documented?on spirometry with a decreased forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio, typically < 0.75 in adults and < 0.9 in children
Variability of airflow obstruction refers to what?improvement or deterioration of lung function and includes reversibility (rapid improvement of airflow obstruction after administration of a bronchodilator) as well as changes occurring over the course of the day, from day to day, or seasonally
*** Documenting excessive variability clinically may occur after short-acting bronchodilator administration (improvement of FEV1 of > 12% or 200 mL from baseline i adults after 10-15 minutes or > 12% in children, true or false?true
What else confirms excessive variability?if improvements are seen after 4 weeks of daily anti-inflammatory controller medication use, this also confirms excessive variability
Why should these determinations not be made in the face of a lung infection?because patients w/ normal lung function and those with non-asthma lung disease (COPD) may also display these changes under such circumstances
What may also confirm the diagnosis of asthma if spirometry is not available, but it is not considered as reliable a test?Diurnal variability of PEF > 10% for adults and > 13% for children over a 2-week period of time
If spirometry suggests asthma, is further testing warranted? How should patients be treated?1) no 2) according to current guidelines
If hx suggests asthma, but spirometry is normal what repeat test is useful?repeat spirometry
What is another option of diagnosis of asthma?The bronchial provocation test where administration of an agent such as inhaled methacholine or histamine is used to stimulate bronchoconstriction, that then can be reversed with a short-acting bronchodilator
Provocation tests have moderate ______ (sensitivity vs. specificity) but limited ______ (sensitivity vs. specificity) for the diagnosis of asthma and are not required for the dx to be made?sensitivity; specificity
If a pt presents w/ acute s/s that are consistent with asthma but dx has not yet been established, what is the appropriate treatment for an exacerbation of asthma?short-acting bronchodilators, oral steroids
Confirmatory testing is recommended after ____ to _____ months, when lung function is expected to be back to baseline?1; 3
Chronic cough may be due to ______ (so called "cough-variant")?asthma
*** Pregnant patients suspected of having asthma may be diagnosed with _____ or _____, but bronchial provocation tests are generally not recommended?spirometry or PEF
What are the absolute contraindications to provocation testing?1) severe airflow limitation (FEV1 < 50% predicted) 2) MI or stroke w/in the last 3 months 3) uncontrolled HTN 4) aortic aneursym
List the relative contraindications to provocation testing?1) inability to perform acceptable-quality spirometry 2) pregnancy or lactation
If a pt is already taking controller medication, but the diagnosis is uncertain, what should be done?spirometry should be performed on current therapy and again after 2 to 4 week step-down in the controller therapy by 25 to 50%. An increase in s/s and objective decreased in pulmonary function is diagnostic of asthma
Fractional exhaled nitric oxide (FEND) is used as a way of what?monitoring actual or anticipated response to coroticosteroid therapy in asthma (recent investigations in the use of FEND for asthma dx are promising in both adults and children, but considerable investigation is needed before it is likely to be come part of a standard diagnostic approach
*** SUMMARY = The standard approach to achieving a diagnosis of asthma remains the use of ______ in an individual with a high level of suspicion for asthma?spirometry
*** SUMMARY = What measurements may also be utilized in diagnosis but have a greater level of variability and less reliablity?PEF (peak expiratory flow)
*** SUMMARY = Provocative testing w/ inhaled _______ is useful when asthma suspicion is high but spirometry is NORMAL?methacholine