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Asthma

Updated: Jan 28


Definition

Criteria for Diagnosis

Asthma Control Test (ACT)

Pathophysiology

Asthma Diagnosis Overview

Symptoms: Wheezing, shortness of breath, chest tightness, cough (often at night/morning).

Spirometry Tests:

  • FEV1: Changes >12% and >200 mL post-bronchodilator suggest asthma.

  • FVC: Total air exhaled.

  • PEF: Variability >20% over a week indicates asthma.

Additional Tests:

  • Methacholine Challenge: FEV1 drop >20% indicates asthma.

  • FeNO Testing: Elevated levels show airway inflammation.

  • Allergy Testing: Identifies triggers.

Response to Medication: Improvement with asthma drugs aids diagnosis.

Exclusion of Other Diagnoses: Ruling out conditions like COPD.

Patient History and Physical Exam: Critical for a comprehensive diagnosis.

Asthma diagnosis involves assessing symptoms, spirometry results, response to medication, and patient history. Additional tests are used if needed. Diagnosis may require multiple tests to confirm the presence of variable airflow obstruction and reversibility.


Management


ACT Score 5-25 Guideline Adjustments


ACT Score 20-25 (Well-Controlled Asthma)

  • Step 1: Intermittent Asthma

  • Definitive Treatment: Low-dose inhaled corticosteroid (ICS) may be sufficient.

  • Prescription: Budesonide 90 mcg, 1 puff inhaled BID.

  • Supportive Treatment: Short-acting beta-agonist (SABA) as needed.

  • Prescription: Salbutamol (Albuterol) 100 mcg, 1-2 puffs inhaled PRN for symptoms.

ACT Score 15-19 (Mildly Uncontrolled Asthma)

  • Step 2: Mild Persistent Asthma

  • Definitive Treatment: Low-dose ICS.

  • Prescription Options:

  • Budesonide 90 mcg, 1 puff inhaled BID.

  • Fluticasone propionate 100 mcg, 1 puff inhaled BID.

  • Supportive Treatment: If symptoms persist, consider adding a long-acting muscarinic antagonist (LAMA) or a long-acting beta-agonist (LABA).

  • Prescription: Tiotropium Bromide (Spiriva) 2.5 mcg, 1 puff inhaled OD.

ACT Score 10-14 (Moderately Uncontrolled Asthma)

  • Step 3: Moderate Persistent Asthma

  • Definitive Treatment: Medium-dose ICS combined with LABA.

  • Prescription: Budesonide 180 mcg/Formoterol 4.5 mcg, 1 puff inhaled BID.

  • Supportive Treatment: Continue LAMA, consider adding leukotriene receptor antagonists or theophylline.

  • Prescription: Montelukast 10 mg, 1 tablet PO QD.

ACT Score 5-9 (Severely Uncontrolled Asthma)

  • Step 4: Severe Persistent Asthma

  • Definitive Treatment: High-dose ICS combined with LABA. Evaluate for biologic therapy eligibility.

  • Prescription: Fluticasone furoate/Salmeterol (Seretide) 500 mcg/50 mcg, 1 puff inhaled BID.

  • Supportive Treatment: Continue LAMA. For allergic asthma, consider omalizumab; during exacerbations, introduce oral corticosteroids.

  • Prescription: Prednisolone 40 mg, 1 tablet PO QD for 5 days during exacerbations.

Important Notes

  • Regular Monitoring: Adjustments should be based on regular ACT scores and clinical assessment monitoring.

  • Patient Education: Educate patients about the importance of adherence to the treatment plan and proper inhaler technique.

  • Follow-Up: Schedule regular follow-up appointments to reassess asthma control and make further adjustments as necessary.

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