1. Diagnosis of asthma in adolescents and adults D.Anan Esmail Seminar Training Primary Care Asthma+ COPD 03 2015

2. Definition of Asthma chronic disorder of the airways

3. Definition of Asthma inflammatory disorder of the airways

4. Definition of Asthma bronchial hyperresponsiveness

5. inflammatory disorder of the airways bronchial hyperresponsiveness airflow obstruction

6. variable and recurring symptoms largely or completely reversible

7. CLINICAL FEATURES

8. Asthma may develop at any age

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

10. Children : Boys > Girls

11. young adulthood at age 22 years Women > Men

12. adults age 65 and older is about 4 to 8 %

13. respiratory symptoms occur with exposure to triggers

14. respiratory symptoms resolve with trigger avoidance

15. respiratory symptoms resolve with asthma medication

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

17. the classic symptoms of asthma Cough worse at nightworse at night

18. the classic symptoms of asthma Shortness of breath

19. WheezeCough Shortness of breath the classic symptoms of asthma

20. Some patients describe clear mucoid or pale yellow sputum

21. historical features heighten the probability of asthma:

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

23. Patients may remain asymptomatic for long periods of time

24. symptoms occur or worsen at night

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

26. Molds Allergens dust mites furry animals Cockroaches pollens

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

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

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

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

31. historic features lessen the probability of asthma:

32. 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

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

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

35. the new onset of asthma remains a possibility

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

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

38. 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

39. tttthe two diseases can co-exist

40. Physical Findings

41. normal if performed in the absence of an acute exacerbation

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

43. Auscultation wheezing prolonged expiratory phase Decreased Respiratory sounds

44. Wheezes characteristic feature of asthma

45. Wheezes not specific for asthma

46. Wheezes absent between asthma exacerbations

47. Wheezes heard on expiration

48. Wheezes can also occur during inspiration

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

50. allergic rhinitis common condition among patients with allergic asthma

51. Nasal polyps Aspirin-Induced Asthma

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

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

54. 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