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so we can characterize aspirin to
various different subtypes as well
chronic asthma this is when you've
developed an element of irreversible
disease leading into chronic dismay or a
chronically low fev1 and reflects poorly
controlled disease over many years an
exacerbation
that's an acute deterioration stimulated
often by the triggers we've just
discussed a severe asthma is an attack
of asthma that's bad enough to require
admission to hospital so as an
exacerbation there requires somebody to
come into hospital status asthmaticus is
one level above that where you have an
exacerbation which is severe enough to
be life-threatening and requires very
close attention to the treatment to
ensure the patient gets better and there
is not an instant response it's not with
a less severe exacerbation one dose of
nebulized is probably normally enough to
restore them to reasonable health in
states - Matt occurs it requires much
more intense treatment though doctors
often used the phrase bronchospasm and
all they mean by that is an episode of
increased bronchial obstruction or
increased episode of Airways obstruction
and that essentially is an exacerbation
avital subtitle asthma include brittle
asthma and these are patients who
actually are relatively well most of the
time but then can have sudden
exacerbations which can be very rapidly
developing I have a patient who went
down into the kitchen one day feeling
perfectly well and next time she woke up
she was in hospital intensive care and
what had happened is that somewhere in
the kitchen something had set off her
asthma attack and fortunately the
postman found her when he came to
deliver a parcel that day of why she
would have been dead that's brittle
asthma very rapid attacks rapid Falls
impede flow very severe and because of
that very dangerous disease difficult
asthma is a range of problems is when
the asthma is poorly controlled and
causing system a major symptoms for the
patient or frequent admissions to
hospital and it's defined as difficult
as to when it's poorly current
controlled despite extensive tarry
and there are a variety of reasons why
there might be not responding to the
treatment
steroid resistant asthma is a subtype of
difficult a smoke which is very specific
it's where steroids which normally work
very well at asthma are not working the
type of information that patient's
asthma is due to does not respond to
corticosteroid therapy for whatever
reason
cough variant asthma is essentially very
mild asthma where the only Simpson the
patient has is cough and this one's
quite hard to diagnose because there's
no wheezing breathlessness and patients
don't think that the cough could be due
to asthma and nor do their doctors
either
occupational hazard already discussed
that's a spur that set off by inhaled
agents you come across during your
occupation it's very important to
identify because clearly the patients
will need to change their job
circumstances either change their job or
and make sure they have protective
equipment when they're doing their job
to try and minimize the disease problems
so how do you make a diagnosis of asthma
essentially we need to prove there's
reversible Airways obstruction now as I
mentioned clinically that may be obvious
in some patients and therefore the
requirement to prove that it's present
is not so important but it can be proved
in other ways one is by response to
treatment somebody comes to you with
episodes of cough and breathlessness and
wheeze and it sounds very much like they
have asthma perhaps it's diurnal
variation it's worse in the morning the
cough wakes them at night every time
they get a cold it's way worse those
sort of patients you probably don't
actually need to do too much besides
give them the right treatment and if
they get better than that sassman if you
really want to prove it asthma peak flow
recordings are a good way of doing that
these record our the airflow during
expiration and they show diurnal
variation in asthmatic so for example in
this chart decir on the right-hand side
of the slide there's a big fall in the
peak flow in the morning now when you
start an inhaled steroid what happens is
that the peak flow will gradually
improve as the aspirant comes under
control but not only that is that the
difference between the morning and
evening the diurnal variation
becomes smaller so home pee flow
recordings women without treatment are a
very good way of identifying patients
who have a smurf for sure and you can
also use spirometry the fev1 and I
showed a paragraph earlier with fev1
which improves substantially after
Branca died - showing significant
reversible disease and therefore what
the patient has asthma other tests well
a blood test may show degree of blood
circulating Asuna philia and they may
the patient often has a raised total IgE
and can be allergic to Asperger's
especially if they have if they have
allergic bronchopulmonary ptosis which
is a complication of asthma which I'll
discuss in a subsequent lecture the
chest x-ray is necessary to make sure
you're not missing any other diseases
but essentially is normal in most
patients with asthma unless they have an
acute attack or chronic severe disease
in which case that will show hyper
expanded lungs but as I said a chest
x-ray is vital during exacerbations at
least to explain sure there's no of
complications such as a low bar collapse
or an infection we often do skin prick
test in patients with asthma and that's
to identify specific allergic triggers
for allergic asthma dust house dust
mites cat fur etc etc in many ways it's
not very practical because if a patient
knows that a cat will upset her his or
her asthma then they avoid cats it's
only particularly relevant I suppose for
patients where you might be considering
allergic bronchopulmonary so as a
diagnosis in which case the skin Brit
test will be positive Asperger's
occasionally you might need you might
come across the patient where it's quite
hard to identify the have asthma and
then we might do things like a histamine
or methacholine challenge test where the
patient inhales his demeanor
methacholine and that causes
bronchoconstriction
in patients who have asthma but it
doesn't in patients who don't have
asthma so that's inducible airway
obstruction it's quite a tricky test
needs to be done in hospital in a
fully-equipped
poorly functional Aurora tree but it can
be used to identify difficult cases of
asthma to diagnose and the sputum itself
may show evidence of Airways information
the president of ESN affiliate when you
send this beauty more for cytology
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