Asthma Patient Assessment

What are common subjective findings of a patient with asthma?

cough ± increased sputum production, SOB, dyspnea, chest tightness, wheezing

True or False: asthma symptoms may vary in time and vary in intensity

true

What are common objective findings of a patient with asthma?

dyspnea, cough, wheezing, tachypnea, low o2 sat, tachycardia, spirometry findings supporting airflow limitation, signs of atopy

What is functional residual capacity?

expiratory reserve volume + residual volume

What is vital capacity?

inspiratory reserve volume + tidal volume + expiratory reserve volume

What is total lung capacity?

inspiratory reserve volume + tidal volume + expiratory reserve volume + residual volume

What is a normal spirometry result?

80% to 120% of predicated value

True or False: there is a single diagnostic test to diagnose asthma

false

What are the 2 defining features of a patient’s history for asthma?

respiratory symptoms and evidence of variable airflow limitations

How can you confirm airflow limitation?

spirometry before and after treatment with bronchodilator (increase in FEV1 >12%)

How is asthma severity assessed?

retrospectively from the level of treatment required to control symptoms and exacerbations

When is asthma severity assess?

after the patient has been on controller treatment for several months; its not static

What classifies asthma as mild?

controlled by step 1 or step 2

What classifies asthma as moderate?

controlled by step 3 or step 4

What classifies asthma as severe?

controlled by step 5

How do we assess symtpom control?

symptom control checklist for over the last 4 weeks

What is on the symtpm control checklist?

1. daytime asthma symtpoms more than twice/week

2. any night waking due to asthma

3. reliever (SABA) for symtpoms more than twice/week *not assessed if using ICS/formoterol

4. any activity limitation due to asthma

What makes a patient’s asthma well controlled?

none of the symptoms on the control checklist

What makes a patient’s asthma partly controlled?

1-2 of the symptoms on the control checklist

What makes a patient’s asthma uncontrolled?

3-4 of the symptoms on the control checklist

What risks should be assessed at every encounter?

exacerbations, fixed airflow limitations, and medication side effects

What medication-related things can be a risk factor for an exacerbation?

ICS not prescribed, poor adherence, incorrect inhaler technique, high SABA use

What comorbidities are risk factors for exacerbations?

obesity, chronic rhinosinusitis, GERD, confirmed food allergy, anxiety, depression, pregnancy

What exposures are risk factors for exacerbations?

smoking, allergen exposure if sensitixed, air pollution

What lung function is a risk factor for an exacerbation?

low FEV1, especially if < 60%

What are other risk factors for exacerbation?

sputum or blood eosinophilia, chronic mucous hypersecretion, preterm birth/low birth weight