Asthma

Asthma is the most common chronic disease among children. At least 75 percent of asthmatic patients demonstrate immediate hypersensitivity to common aeroallergens. Asthma triggers include viral infections; environmental pollutants, such as tobacco smoke; certain medications, (aspirin, nonsteroidal anti-inflammatory drugs), and sustained exercise, particularly in cold environments. I. Diagnosis A. History

1. Symptoms of episodic complaints of breathing difficulties, seasonal or nighttime cough, prolonged shortness of breath after a respiratory infection, or difficulty sustaining exercise.

2. Reversible airways disease does not always represent asthma. Wheezing may persist for weeks after an acute bronchitis episode. Patients with chronic obstructive pulmonary disease may have a reversible component superimposed on their fixed obstruction. Etiologic clues include a personal history of allergic disease, such as rhinitis or atopic dermatitis, and a family history of allergic disease.

3. The frequency of daytime and nighttime symptoms, duration of exacerbations and asthma triggers should be assessed.

Asthma Triggers

Sources of inhaled allergens

Environmental irritants/precipitants

House dust mites

Tobacco smoke

Animal danders from house pets

Cold air

Pollen

Exercise

Fungal spores

Particulates from wood stoves

Cockroaches

Air pollution

Animal urine from laboratory ani-

Chemical gases or fumes

mals

Drugs

Infections

Aspirin

Viral respiratory infections

Nonsteroidal anti-inflammatory

Sinusitis

drugs

Gastroesophageal reflux

Angiotensin converting enzyme in

Sulfites (used as preservatives in

hibitors

food, beer and wine)

Beta blockers

B. Physical examination. Hyperventilation, use of accessory muscles of respiration, audible wheezing, and a prolonged expiratory phase are common. Increased nasal secretions or congestion, polyps, and eczema may be present. The chest and lungs should be assessed for wheezing.

C. Measurement of lung function. An increase in the forced expiratory volume in one second (FEV,) of 12 percent after treatment with an inhaled beta2 agonist is sufficient to make the diagnosis of reversible airways disease. A similar change in peak expiratory flow rate (PEFR) measured on a peak flow meter is also diagnostic.

Asthma Classification

Symptoms

Classification

Daytime

Nighttime

Lung function

Mild intermittent

Symptoms occur up to 2 times/week; exacerbations are brief (hours to days), with normal PEFR and no symptoms between exacerbations

Symptoms occur up to 2 times/month

PEFR or FEV1 >80% of predicted; <20% variability in PEFR

Mild persistent

Symptoms occur more than 2 times/week but less than one time/day; exacerbations may affect normal activity

Symptoms occur more than 2

times/month

PEFR or FEV, >80% of predicted; PEFR variability 20-30%

Moderate persistent

Symptoms occur daily; daily need for inhaled short-acting beta2 agonist; exacerbations affect normal activity; exacerbations occur more than 2 times/week and may last for days

Symptoms occur more than one time/week

PEFR or FEV1 >60 but <80% of predicted; PEFR variability >30%

Severe persistent

Symptoms are continual; physical activity is limited; exacerbations are frequent

Symptoms are frequent

PEFR or FEV1 <60% of predicted; PEFR variability >30%

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