Asthma
Transcript: Moderate Differential Diagnosis Bloods Sputum culture, FBC, U&E, CRP, Blood cultures Risk of death Specialist supervision indefinitely Investigation Prominent dizziness, light-headedness, peripheral tingling Chronic productive cough in absence of wheeze or breathlessness Repeatedly normal examination of chest when symptomatic Voice disturbance Symptoms with colds only Significant smoking history (>20 pack years) Cardiac disease Normal PEF or spirometry when symptomatic > symptoms PEF >50-75% best or predicted No features of acute severe asthma Diagnosis Less likely if: Characteristic Pattern of symptoms Absence of alternative explanation More Likely if: Acute Asthma Clinical Severe breathlessness, tachypnoea, tachycardia, silent chest, cyanosis or collapse PEF or FEV1 PEF1 = expressed as% of the patients previous best value is most useful clinically Pulse oximetry SpO2 adequacy of oxygen therapy and need for ABG Aim of oxygen therapy = maintain 94-98% ABG SpO2 < 92% or other features of life threatening require it <PaO2 & <PaCO2 = hyperventilation If > PaC02 HDU/ICU for ventilation Chest X-ray Not unless Suspect pneumothorax, consolidation, life threatening asthma, fail to respond to treatment, require ventilation >1 of: Wheeze, breathlessness, chest tightness and cough Especially if: Worse at night and early morning In response to exercise, allergen, cold After taking aspirin or beta blockers History of atopic disorder Fx asthma/atopic disorder Widespread wheeze on auscultation Otherwise unexplained low FEV1 or PEF (2 readings) Otherwise unexplained peripheral blood eosinophilia Pulmonary OedemaCOPD Large airway obstruction – foreign body/tumour SVC obstruction – wheeze/dyspnoea not episodic Pneumothorax PE Bronchiectasis Obliterative bronchiolitis Asthma Acute Management
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