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Asthma Diagnosis and Monitoring

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Presentation by Dr. S.K Jindal on "Asthma Diagnosis and Monitoring" including breath analysis, causes of wheezing, severity assessment, etc. For more information, please contact us: : 9779030507. – PowerPoint PPT presentation

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Date added: 20 June 2024
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Title: Asthma Diagnosis and Monitoring


1
ASTHMADiagnosis and Monitoring
  • Dr. S. K. Jindal
  • www.jindalchest.com

2
Key Issues
  • Underdiagnosis / Misdiagnosis and ?
    Overdiagnosis
  • Establishing diagnosis criteria
  • Severity assessment / Classification
  • Monitoring

3
Establishing Diagnosis
  1. Clinical features
  2. Demonstration of airway obstruction
  3. Variability and reversibility of A.O.
  4. Excluding other causes of wheezing / airway
    obstruction
  5. Establishing hypersensitivity
  6. Assessment of reversibility
  7. Demonstration of inflammation

4
Clinical Features
  • Symptoms Episodic
  • Cough, breathlessness
  • Wheezing, chest congestion
  • heaviness
  • Expectoration Nil to profuse
  • Frothy to purulent
  • Signs Hyperinflated chest
  • Rhonchi, crackles
  • General systemic

5
Airway Obstruction
  • Physical examination
  • Wheezing, prolonged expiration
  • Measuring forced expiratory time
  • Chest roentgenography
  • PEF measurement
  • Spirometry ?FEV1, FEV1/VC
  • Airway resistance

6
Establishing 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

7
Utility 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
8
Excluding other causes of wheezing / A.O.
  • Sputum examination
  • Chest roentgenography
  • Plain CXR
  • CT Scanning
  • Bronchoscopic examination
  • Others Upper airway exam
  • Spirometry

9
All that wheezes isNot AsthmaandAll
asthmadoes not wheeze
10
(No Transcript)
11
Establishing hypersensitivity
  • History of other allergies past or present
  • Family history of atopy
  • Blood / sputum eosinophilia
  • Hypersentivity skin tests
  • Bronchial hyperresponsiveness
  • Serum IgE estimation

12
Demonstration of Inflammation
  • Clinical features
  • Markers of inflammation
  • Direct Bronchial biopsy
  • Indirect BHR
  • Induced sputum
  • Breath analysis

13
Clinical Uses of Markers
  • Differential diagnosis
  • Disease severity
  • Treatment response
  • Research uses
  • Study of kinetics

14
Breath analysis
  • Exhaled NO
  • Volatile gases
  • CO, Ethane, Pentane
  • Endogenous substances
  • Inflammatory Mediators
  • Cytokines
  • Oxidants

15
Severity Assessment
  • Symptoms Respir distress
  • Work performance
  • Mentation
  • Physical exam Indices
  • Pulse, R.R., BP
  • Breath sounds
  • Paradox (etc.)
  • PEF and FEV1
  • Blood gas measurement

16
Monitoring
  • Symptom relief / recurrence
  • Acute episodes
  • Treatment response
  • Drug side effects
  • Disease chronicity / irreversibility

17
Diurnal 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

18
A hypothetical PEF rhythm in asthma
(Jindal et al, J Asthma 2002)
19
Visual Analogue Scale
R 0.5255, p lt0.01
R 0.4609, p lt0.01
Gupta et al, IJCDAS 2000
20
Conclusions
  • 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
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