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Module 5
Diagnosis of
asthma
Departemen IKA FKUI-RSCM
UKK Respirologi PP IDAI
Definition of asthma
Reversible respiratory tract obstruction
spontaneously or after treatment
1950-es
1960-es
1970-es
PREVENTION OF BRONCHOSPASM
WHO, 1975
1990-es
GINA, 2004
Pathogenesis
Environment
Genetic susceptibility
Resume
Resume..
Bronchoconstriction
Chronic
inflammation
Remodeling
Inflammation in asthma
Inflamasi akut
Steroid
response
Chronic inflammation
Structural changes
Time
Barnes PJ
Operational definition
A condition with episodic wheezing and/or cough with
asthma as the most possible etiology, while other
infrequent causes have been excluded
1989:
1992:
Recurrent wheezing and/or persistent cough with
asthma as the most possible etiology, while other
infrequent causes have been excluded
Warner dkk. Pediatr Pulmonol 1998;25:1-7
1998:
Diagnosis
Cough and/or Wheeze
Clinical history
Physical examination
Mantoux test
Suggestive of asthma:
Episodic
Nocturnal
Seasonal
Exertional
Atopic
Consider
Chest and sinus x rays
Lung function
Bronchial challenge and/or
Bronchodilator response
Bronchodilator response
Response
No
response
.. Consider :
Sweat test
Immune function
Ciliary & Reflux studies
WD/ Asthma
Assess severity and etiology
- ve
+ ve
PNAA, 2004:
Entry point of asthma diagnosis:
Recurrent Wheezing
and/or
Chronic Recurrent Cough
Batasan operasional
Recurrent cough and/or wheezing with
characteristics episodic, nocturnal (variability),
reversible (relieve with or without treatment) plus
atopic
TYPICAL
Episodic
Nocturnal
After activity
Atopic (+)
Reversibility (+)
Variability (+)
Bronchodilator
Not Asthma
ASTHMA
FVC
Lung
Function
Test
AEJ
AES
AP
.
FEV1
V50
PEF
V25
Asthma, 2 aspects
Asthma : chronic respiratory disease that
can have acute attack (two in one
disease)
Chronic Asma
Asthma
Acute Asthma
Acute asthma
1. Infrequent
episodic asthma
2. Frequent
episodic asthma
1. Mild attack
2. Moderate
attack
3. Severe attack
3. Persistent
asthma
Persistent Asthma
Classification of disease
Clinical parameters
and lung function
Infrequent episodic
asthma
Frequent episodic
asthma
Persistent asthma
Freq of attacks
< 1x /month
> 1x /month
Daily
Duration of attacks
< 1 week
>1 week
Daily
Between episodes
No symptoms
Symptoms (+)
Frequent nocturnal
symptoms
Normal
May affect
Affect
Physical exam
Normal
May affect
Abnormal
Controller
No need
Steroid/combination
Steroid/combination
Lung function
(No attacks)
PEF/FEV1 >80%
Variability (attacks)
>15%
PEF/FEV1 <60%
PEF/FEV1 60-80%
Variability 20-30%
> 30%
> 50%
Diagnosis
ASTHMA
Asthma Attack
Severe Asthma
Asthma labelling
Chronic condition + present condition
Chronic condition: infrequent -- persistent
Present condition:
(-)
Symptom
attack (-)
(+)
attack (+)
Allergic March
Rinitis
Asma
Dermatitis atopik
Alergi makanan
0
6
bulan
1
tahun
3
tahun
7
tahun
15
tahun
Transient
Asthma
Wheezing prevalence
Non-Atopic
Wheezers
BHR of atopic
asthma
Post
RSV
0
6
Age (years)
11
Fig. 6. Hypothetical peak prevalence by age for the 3 different wheezing phenotypes.
The prevalence for each age interval should be the area under the curve. This does not
imply that the groups are exclusive.
Taussig LM, et al. JACI 2003; 111:661-675
Recurrent wheezing
Major :
Atopic dermatitis
Asthma in parent
Skin test (+) aeroallergen
Minor
Hypereosinophilia
Wheezing beyond flu
Rhinitis allergic
Skin test (+) ingestion
Asthma: if
2 major and/or
1 major + 2 minor
Cost ?
Availability ?
Conclusion
Alteration of asthma pathogenesis:
bronchospasm chronic inflammation
remodeling
Diagnosis of asthma must included
classification and severity of attack
It is difficult to diagnose asthma in
preschool children
There is asthma prediction index in children
<3 years of age (major and minor criteria)
Thanks for
your attention
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