Case 11
Asthma management
,Diagnosis
,Diagnostic Pathway
• The diagnostic pathway depends on:
The pretest probability for the diagnosis, response to therapy and
clinical suspicion for alternative diagnosis.
• How does the diagnostic question differ in patients with and witho
flow obstruction?
With airflow obstruction: the clinician is seeking for a clinical diagno
of asthma. **
without airflow obstruction: how intensive the corticosteroid therap
should be. **
• The key point is the history is to establish that symptoms are varia
& linked to airflow obstruction or eosinophilic inflammation.
, Cont.
• Vocal cord or glottis dysfunction can cause serious diagnostic
difficulties. Why?
Because it causes wheezing that can be heard along all lung fields.
• In Some patients, the noise occurs purely for a psychological reason
usually are 16-50 females patients.
• If patients had normal spirometry findings, all tests of airflow
obstruction lack the sensitivity
--- >> assessment of hyper-responsiveness is more sensitive,
absence of hyper-responsiveness should prompt consideration to an
alternative diagnosis.
Asthma management
,Diagnosis
,Diagnostic Pathway
• The diagnostic pathway depends on:
The pretest probability for the diagnosis, response to therapy and
clinical suspicion for alternative diagnosis.
• How does the diagnostic question differ in patients with and witho
flow obstruction?
With airflow obstruction: the clinician is seeking for a clinical diagno
of asthma. **
without airflow obstruction: how intensive the corticosteroid therap
should be. **
• The key point is the history is to establish that symptoms are varia
& linked to airflow obstruction or eosinophilic inflammation.
, Cont.
• Vocal cord or glottis dysfunction can cause serious diagnostic
difficulties. Why?
Because it causes wheezing that can be heard along all lung fields.
• In Some patients, the noise occurs purely for a psychological reason
usually are 16-50 females patients.
• If patients had normal spirometry findings, all tests of airflow
obstruction lack the sensitivity
--- >> assessment of hyper-responsiveness is more sensitive,
absence of hyper-responsiveness should prompt consideration to an
alternative diagnosis.
