Asthma Revision Pack
Definition of Asthma
- Chronic respiratory disease, which is characterised by reversible airway inflammation and
hyper-responsiveness.
- Key points covered:
1. Chronic.
2. Reversible airflow limitation.
3. Inflammatory.
4. Airway hyper-responsiveness.
- “CHAIR”: CHronic, Airway hyper-responsiveness, Inflammatory, Reversible airflow
limitation.
1. CH – CHronic.
2. A – Airway hyper-responsiveness.
3. I – Inflammatory.
4. R – Reversible airflow.
- “CHIRP”: Chronic, Hyper-responsiveness, Inflammation, Reversible, Polyphonic wheeze.
1. C – Chronic.
2. H – Hyper-responsiveness.
3. I – Inflammation.
4. R – Reversible.
5. P – Polyphonic wheeze.
Asthma Diagnosis
1. Step 1: clinical suspicion (based on history and symptoms).
2. Step 2: objective testing.
Clinical picture
- Coughing (worse at night or early morning).
- Wheezing.
- Dyspnoea (shortness of breath).
- Chest tightness.
- Symptoms vary day to day/ season to season/ with triggers.
- Episodic- comes and goes.
Asthma VS COPD
- Onset: asthma: early (<40), COPD: later (>35).
- Reversibility: asthma: reversible, COPD: irreversible.
- Inflammation: asthma: eosinophilic, COPD: neutrophilic.
- Triggered by: asthma: allergens, cold, COPD: smoking.
- Symptom pattern: asthma: variable, COPD: persistent.
First-Line Tests in Adults > 16
- Use either:
1. FeNO: greater than or equal to 50ppb suggests asthma.
, 2. Blood eosinophils: greater than or equal to 300 suggests asthma.
- High FeNO = high inflammation = asthma.
Second-Line Test: Spirometry
- Look for:
1. FEV1 increase greater than or equal to 12% AND
2. + 200ml post-bronchodilator.
- Diagnostic of reversibility = asthma!
- Also note that FEV1/ FVC < 0.7 suggests obstruction.
Third-Line Test: Peak Flow Monitoring (PEFR)
- Over 2 weeks:
1. Do 3 readings twice a day.
2. Look for variability greater than 20%- suggests asthma.
- Example: Best: 450L, Worst: 300L, Average: 375L.
450/375 = 120%, 300/375 = 80% → 40% variability
Children: 5-16
- Lower FeNO threshold: greater than or equal to 35 ppb.
- Spirometry greater than or equal to 12% improvement.
- Unsure: skin prick test, IgE, eosinophils.
- Under 5s: no objective testing: treat based on clinical judgement.
Mnemonic: "B-FSP" (Breathe For Some Proof)
- For asthma diagnosis:
1. B – Blood eosinophils
2. F – FeNO
3. S – Spirometry
4. P – Peak flow
Old VS New Guidelines
- Initial therapy: old: ICS + SABA, new: ICS-formoterol combo from diagnosis (AIR).
- Reliever: old: salbutamol (SABA), new: formoterol + ICS in one inhaler.
- Preventer: old: ICS alone or ICS + LABA, new: ICS + formoterol (used regularly and when
needed).
- Philosophy: old: step-up, step-down, new: anti-inflammatory from day 1.
RECAP: Stepwise Management (New Guidelines)
- Step 1 – Mild → AIR (budesonide-formoterol PRN).
- Step 2 – Moderate → MART (daily + PRN).
- Step 3 – Poor control? → Moderate-dose MART.
- Step 4 – Add LTRA or LAMA.
- Step 5 – Refer for biologics.
Air Therapy
- Anti-inflammatory Reliever:
- Uses ICS + formoterol when symptoms occur.
Definition of Asthma
- Chronic respiratory disease, which is characterised by reversible airway inflammation and
hyper-responsiveness.
- Key points covered:
1. Chronic.
2. Reversible airflow limitation.
3. Inflammatory.
4. Airway hyper-responsiveness.
- “CHAIR”: CHronic, Airway hyper-responsiveness, Inflammatory, Reversible airflow
limitation.
1. CH – CHronic.
2. A – Airway hyper-responsiveness.
3. I – Inflammatory.
4. R – Reversible airflow.
- “CHIRP”: Chronic, Hyper-responsiveness, Inflammation, Reversible, Polyphonic wheeze.
1. C – Chronic.
2. H – Hyper-responsiveness.
3. I – Inflammation.
4. R – Reversible.
5. P – Polyphonic wheeze.
Asthma Diagnosis
1. Step 1: clinical suspicion (based on history and symptoms).
2. Step 2: objective testing.
Clinical picture
- Coughing (worse at night or early morning).
- Wheezing.
- Dyspnoea (shortness of breath).
- Chest tightness.
- Symptoms vary day to day/ season to season/ with triggers.
- Episodic- comes and goes.
Asthma VS COPD
- Onset: asthma: early (<40), COPD: later (>35).
- Reversibility: asthma: reversible, COPD: irreversible.
- Inflammation: asthma: eosinophilic, COPD: neutrophilic.
- Triggered by: asthma: allergens, cold, COPD: smoking.
- Symptom pattern: asthma: variable, COPD: persistent.
First-Line Tests in Adults > 16
- Use either:
1. FeNO: greater than or equal to 50ppb suggests asthma.
, 2. Blood eosinophils: greater than or equal to 300 suggests asthma.
- High FeNO = high inflammation = asthma.
Second-Line Test: Spirometry
- Look for:
1. FEV1 increase greater than or equal to 12% AND
2. + 200ml post-bronchodilator.
- Diagnostic of reversibility = asthma!
- Also note that FEV1/ FVC < 0.7 suggests obstruction.
Third-Line Test: Peak Flow Monitoring (PEFR)
- Over 2 weeks:
1. Do 3 readings twice a day.
2. Look for variability greater than 20%- suggests asthma.
- Example: Best: 450L, Worst: 300L, Average: 375L.
450/375 = 120%, 300/375 = 80% → 40% variability
Children: 5-16
- Lower FeNO threshold: greater than or equal to 35 ppb.
- Spirometry greater than or equal to 12% improvement.
- Unsure: skin prick test, IgE, eosinophils.
- Under 5s: no objective testing: treat based on clinical judgement.
Mnemonic: "B-FSP" (Breathe For Some Proof)
- For asthma diagnosis:
1. B – Blood eosinophils
2. F – FeNO
3. S – Spirometry
4. P – Peak flow
Old VS New Guidelines
- Initial therapy: old: ICS + SABA, new: ICS-formoterol combo from diagnosis (AIR).
- Reliever: old: salbutamol (SABA), new: formoterol + ICS in one inhaler.
- Preventer: old: ICS alone or ICS + LABA, new: ICS + formoterol (used regularly and when
needed).
- Philosophy: old: step-up, step-down, new: anti-inflammatory from day 1.
RECAP: Stepwise Management (New Guidelines)
- Step 1 – Mild → AIR (budesonide-formoterol PRN).
- Step 2 – Moderate → MART (daily + PRN).
- Step 3 – Poor control? → Moderate-dose MART.
- Step 4 – Add LTRA or LAMA.
- Step 5 – Refer for biologics.
Air Therapy
- Anti-inflammatory Reliever:
- Uses ICS + formoterol when symptoms occur.
