§Bronchiectasis (bronchial wall thickening on CT scan)
§Lung cancer
> 8 weeks duration
Asthma
§Symptoms consistent with asthma: recurrent cough, wheeze, shortness of breath and/or chest
tightness This is the triad of asthma). Symptoms occur or worsen at night, exercise, viral respiratory
infections, aeroallergens and/or pulmonary irritants (such as second-hand smoke)
§Airflow obstruction is at least partially reversible
Cough Dx
perform spirometry if indicators are present
Peak flow meter
is used for monitoring, not for diagnosing asthma
§Presence of inflammation
is what distinguishes asthma from COPD
, §Asthma is a chronic disease. Prevention is the treatment approach
§Requires frequent followups
Risk factors for death from asthma...?SABA?
§Infants <1 year old
§Previous severe exacerbations
§>2 hospitalizations in the past year
§>3 ED visits in past year
§Hospitalization/ED visit in past month
§>2 canisters SABA use per month
??is the asthma care plan?
§Differential dx asthma
GERD
§COPD
§CHF
§Obesity
§Panic disorder
§Bronchogenic cancer
§Evidence of variable expiratory airflow limitation (reduced FEV1/FVC ratio)
§Symptoms usually worse at night and with viral infections
§Is asthma intermittent or persistent?
§How often are symptoms?
§If SABA used greater than 2 weeks, add low dose inhaled steroid
§Mild persistent asthma
§2 X week but less that once daily
§Low dose inhaled steroid with SABA for rescue prn
§If SABA used more than 2X weekly, "step up" therapy to medium dose inhaled steroid
§Moderate persistent "4"
§Daily symptoms but not all day
§Medium dose inhaled steroid daily plus LABA and SABA for rescue PRN
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