Diagnosis of asthma in adolescents and adults D.Anan Esmail Seminar Training Primary Care Asthma+ COPD

Definition of Asthma chronic disorder of the airways

Definition of Asthma inflammatory disorder of the airways

Definition of Asthma bronchial hyperresponsiveness

inflammatory disorder of the airways bronchial hyperresponsiveness airflow obstruction

variable and recurring symptoms largely or completely reversible

CLINICAL FEATURES

Asthma may develop at any age

diagnosed before the age of seven years in approximately 75 % of cases

Children : Boys > Girls

young adulthood at age 22 years Women > Men

adults age 65 and older is about 4 to 8 %

respiratory symptoms occur with exposure to triggers

respiratory symptoms resolve with trigger avoidance

respiratory symptoms resolve with asthma medication

the classic symptoms of asthma Wheeze high-pitched whistling soundhigh-pitched whistling sound usually upon exhalationusually upon exhalation

the classic symptoms of asthma Cough worse at nightworse at night

the classic symptoms of asthma Shortness of breath

WheezeCough Shortness of breath the classic symptoms of asthma

Some patients describe clear mucoid or pale yellow sputum

historical features heighten the probability of asthma:

Episodic symptoms Asthmatic symptoms come and go with a time course of hours to days

Patients may remain asymptomatic for long periods of time

symptoms occur or worsen at night

Characteristic triggers Respiratory symptoms triggered by (Exercise, cold air, Viral infections, exposure to inhaled allergens) suggestive of asthma

Molds Allergens dust mites furry animals Cockroaches pollens

irritant-type exposures cigarette smokeDusts changes in weather airborne chemicals strong fumes

Work-related exposures asthmatic symptoms temporally associated with work-related exposures occupational asthma

The diagnosis can be confirmed by demonstration of variable airflow obstruction before and after a work shift

Personal or family history of atopy aaaatopic dermatitis aaaallergic rhinitis favors a diagnosis of asthma

historic features lessen the probability of asthma:

Lack of improvement following anti- asthmatic medications PPPPatients who have tried an inhaled bronchodilator and obtained no relief of their symptoms less likely to have asthma

PPPPatients who have tried course of oral glucocorticoids and obtained no relief of their symptoms less likely to have asthma glucocorticoids

Onset of symptoms after age 50 In middle-aged and older patients, other respiratory and cardiovascular diseases become the more likely explanation for symptoms

the new onset of asthma remains a possibility

cccchest pain LLLLightheadedness SSSSyncope PPPPalpitations suggest an alternate diagnosis

aaaalternate diagnosis pulmonary vascular disease Cardiomyopathy early coronary artery disease Pericardial disease

History of cigarette smoking ppppatients with more than 20 pack-years of cigarette smoking Likely the etiology shifts away from asthma toward COPD

tttthe two diseases can co-exist

Physical Findings

normal if performed in the absence of an acute exacerbation

Inspection increased anterior- posterior diameter of the chest due to air trapping

Auscultation wheezing prolonged expiratory phase Decreased Respiratory sounds

Wheezes characteristic feature of asthma

Wheezes not specific for asthma

Wheezes absent between asthma exacerbations

Wheezes heard on expiration

Wheezes can also occur during inspiration

Extrapulmonary physical findings in patients with asthma that can provide evidence for or against diagnosis of asthma

allergic rhinitis common condition among patients with allergic asthma

Nasal polyps Aspirin-Induced Asthma

Atopic dermatitis risk factor for later Asthma third of patients with atopic dermatitis develop asthma

Clubbing not a feature of asthma direct the clinician toward alternative diagnoses (interstitial lung disease, lung cancer, bronchiectasis )

History Symptoms CoughWheeze Shortness of Breath Triggers of asthma Exercise cold air Viral infections exposure to inhaled allergens Allergic history SkinFoodRespiratory Family history Child's medical history Physical examination