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ASTHMA

ASTHMA. 22/06/2011. Today’s session. Asthma – an introduction (Vanessa) Diagnosis and management of chronic asthma in line with current BTS guidelines (Dr Lowery ) 3 x Case studies (Dr Lowery ) Tea break (3.15-3.30) Childhood asthma (Vanessa) Asthma & QoF AKT questions (Adam)

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ASTHMA

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  1. ASTHMA 22/06/2011

  2. Today’s session • Asthma – an introduction (Vanessa) • Diagnosis and management of chronic asthma in line with current BTS guidelines (Dr Lowery) • 3 x Case studies (Dr Lowery) • Tea break (3.15-3.30) • Childhood asthma (Vanessa) • Asthma & QoF • AKT questions (Adam) • Questions and feedback

  3. Objectives • Definition of asthma • Who gets asthma and what causes it • How to diagnose and manage adult and childhood asthma in line with current BTS guidelines • Recognise signs of uncontrolled asthma • How to recognise, manage and follow up patients with an acute exacerbation • Management of Asthma during pregnancy • QoF and achieving targets

  4. Asthma in adults – an introduction By Dr Vanessa Kerai

  5. DEfinition Asthma is a chronic inflammatory disorder of the airways characterised by: • Pulmonary symptoms • Reversible airway obstruction • Evidence of bronchial hyper-reactivity.

  6. Who gets it? • The prevalence of asthma is increasing globally • More common in Western and affluent societies • The prevalence of treated asthma in the UK is approximately 7% • 90% of people are diagnosed before the age of 6 years. • Asthma is more common in boys than girls, but boys are more likely to "grow out of it" and so asthma is more common in women than men • Asthma is more common in people with a personal history of atopy and in people with a family history of asthma or atopy.

  7. history • Expiratory wheeze • Shortness of breath • Chest tightness • Cough • Patients with asthma often have variable and intermittent symptoms • Their symptoms are frequently worse in the early hours of the morning • Consider other pathology in patients only complaining of a cough or cough as a main symptom. • A family history of asthma • A personal history of atopy • Think about occupational asthma in adult onset especially if symptoms worse at work

  8. triggers • Exercise • Respiratory infections • Environmental irritants • Allergens • Medication • Co-existent rhinitis

  9. Objective testing • Wherever possible you should do objective tests to confirm the diagnosis of asthma before starting long-term treatment. • Patients with asthma and chronic obstructive pulmonary disease both have airflow obstruction • Patients with asthma have reversible obstruction. Improvement can occur spontaneously or as a result of treatment • You should express airflow obstruction as a percentage of the patient's predicted peak flow rate or forced expiratory volume in one second (FEV1) or as a percentage of their best peak flow rate.

  10. Variability testing • Patients should test their peak flow rate every morning and night for two weeks, with additional readings if they meet a trigger, or feel their symptoms. Best readings out of three attempts. • Likely to have asthma if there is a 20% variation in the peak flow recording (often with lower readings in the mornings than the evenings) on three or more days out of 14. • However a negative test does not exclude the diagnosis (it is a specific but not a sensitive test).

  11. Exercise variability • You could ask your patient to do this if you suspect exercise induced asthma. • The patient should measure their PEFR and then exercise for 6 minutes. They should then repeat the peak flow every 10 mins for 30 mins. • A fall of 20% in the PEFR during the test is diagnostic of asthma, but a negative test does not exclude the diagnosis.

  12. Bronchodilator reversibility • Measure the PEFR or FEV1 before and after inhalation of a short-acting beta2 agonist • Asthma is likely if: • The PEFR increases by 20% from the baseline (and also by at least 60 l/min) or • The FEV1 increases by 15% (and also by at least 200 ml). • A negative test does not exclude the diagnosis.

  13. Steroid reversibility • You can do this with a six week course of inhaled steroids or a two week course of oral steroids. • Steroid reversibility trials may help to distinguish asthma from COPD. • This involves measuring the patient's PEFR (or FEV1) before and after a trial of steroid either orally or inhaled. • Asthma is likely if: • The PEFR increases by 20% from the baseline (and also by at least 60 l/min) or • The FEV1 increases by 15% (and also by at least 200 ml). • If there is no reversibility or variability in airflow obstruction, this does not exclude the diagnosis but you should consider an alternative diagnosis

  14. Other tests • Chest xray in patients with atypical symptoms (such as unilateral chest signs, haemoptysis or excessive purulent sputum) and those who do not respond to treatment.

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