Title: Asthma Diagnosis and Monitoring
1ASTHMADiagnosis and Monitoring
- Dr. S. K. Jindal
- www.jindalchest.com
2Key Issues
- Underdiagnosis / Misdiagnosis and ?
Overdiagnosis - Establishing diagnosis criteria
- Severity assessment / Classification
- Monitoring
3Establishing Diagnosis
- Clinical features
- Demonstration of airway obstruction
- Variability and reversibility of A.O.
- Excluding other causes of wheezing / airway
obstruction - Establishing hypersensitivity
- Assessment of reversibility
- Demonstration of inflammation
4Clinical Features
- Symptoms Episodic
- Cough, breathlessness
- Wheezing, chest congestion
- heaviness
- Expectoration Nil to profuse
- Frothy to purulent
- Signs Hyperinflated chest
- Rhonchi, crackles
- General systemic
5Airway Obstruction
- Physical examination
- Wheezing, prolonged expiration
- Measuring forced expiratory time
- Chest roentgenography
- PEF measurement
- Spirometry ?FEV1, FEV1/VC
- Airway resistance
6Establishing variability / reversibility
- History of paroxysmal symptoms, variable physical
findings - Exacerbations on exercise and other trigger
exposures - Broncho reversibility test
- gt15 increase in FEV1 /or FVC after S (200mg)
- Bronchial hyperresponsiveness
- Airway inflammation
7Utility of amplitude mean as a discriminator of
asthma
A
B
C
Cut-offs A 12.5 B 16.5 C 20.0
Aggarwal et al, J Asthma 2002
8Excluding other causes of wheezing / A.O.
- Sputum examination
- Chest roentgenography
- Plain CXR
- CT Scanning
- Bronchoscopic examination
- Others Upper airway exam
- Spirometry
9All that wheezes isNot AsthmaandAll
asthmadoes not wheeze
10(No Transcript)
11Establishing hypersensitivity
- History of other allergies past or present
- Family history of atopy
- Blood / sputum eosinophilia
- Hypersentivity skin tests
- Bronchial hyperresponsiveness
- Serum IgE estimation
12Demonstration of Inflammation
- Clinical features
- Markers of inflammation
- Direct Bronchial biopsy
- Indirect BHR
- Induced sputum
- Breath analysis
13Clinical Uses of Markers
- Differential diagnosis
- Disease severity
- Treatment response
- Research uses
- Study of kinetics
14Breath analysis
- Exhaled NO
- Volatile gases
- CO, Ethane, Pentane
- Endogenous substances
- Inflammatory Mediators
- Cytokines
- Oxidants
15Severity Assessment
- Symptoms Respir distress
- Work performance
- Mentation
- Physical exam Indices
- Pulse, R.R., BP
- Breath sounds
- Paradox (etc.)
- PEF and FEV1
- Blood gas measurement
16Monitoring
- Symptom relief / recurrence
- Acute episodes
- Treatment response
- Drug side effects
- Disease chronicity / irreversibility
17Diurnal PEF variabilityMathematical expressions
- Amplitude percent mean
- Standard deviation percent mean
- Amplitude percent maximum
- Amplitude percent minimum
- Lowest percent personal best
- Lowest percent predicted
- Maximum/minimum percent
- Amplitude percent mesor
18A hypothetical PEF rhythm in asthma
(Jindal et al, J Asthma 2002)
19Visual Analogue Scale
R 0.5255, p lt0.01
R 0.4609, p lt0.01
Gupta et al, IJCDAS 2000
20Conclusions
- PEF variability is a useful marker of asthma in
epidemiological studies and day to day management - Poor sensitivity in clinical diagnosis,
population screening, assessment of severity
21 THANK YOU