Thursday, December 9, 2021 INTEGRATED HEALTH SCIENCE 1

KING FAISAL UNIVERSITY

COLLEGE OF MEDICINE
IN ALAHSA

MS : QASIM AL-HALEIMI
207002113

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 CASE #1

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 CONTENTS

• INTRODUCTION.
• LUNG FUNCTION TESTS.
• EXERCISE TESTS.
• HEAMTOLOGIC AND SPUTUM TESTS.
• SKIN TESTS.
• IMAGING.
• AIRWAY RESPONSIVENESS.
• Exhaled Nitric Oxide.
• DIFFERANTIAL DIAGNOSIS.

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 INTRODUCTION
• Asthma diagnosis is usually apparent from
the symptoms of variable and intermittent
airways obstruction, but is usually confirmed
by measurements of lung functions.

• Most of the tests are used for management

of the condition and detection of the
complications.
• In Emergency situation treatment is done
without any investigations.
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 LUNG FUNCTION TESTS
• Two devices are used:
• Spirometry.
• Peak flow meter.
• Used for measuring reducing (FEV1,FEV1/FVC, & PEF).
• Measurement is done twice before and after treatment.
• Oximetry: to measure the amount of oxygen in your
bloodstream.
• Measurement twice daily to monitor diurnal variation.
• A 15% or greater improvement in FEV1 from the baseline15 min
after use of an inhaled short-acting β2-agonist e.g. salbutamol
is important for monitoring the effect of the drug as well as for the
diagnosis to be sure.
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 Respiratory Function Tests
Tests of examining airways functions
Spirometry The peak flow meter
(PEF)
Expensive Inexpensive
Impractical Practical
for home use measure lung function
)Hospital, offices( in any place
Accurate Rough (less accurate)
 Spirometry Peak Flow Meter

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 Zone System of PEF Meter for
Evaluation of Breathing:
80% - 100% of personal best
ALL
This indicates good lung function
CLEAR
Follow the routine treatment for maintaining
asthma control
50% - 80% of personal best
CAUTION
Patient may need more aggressive
medical management for asthma
50% or less of personal best
MEDICAL Patient needs immediate treatment with
ALERT an inhaled bronchodilator
Notify his physician or seek emergency care
 EXERCISE TESTS
• This test is useful in the diagnosis of EIA.
• This test is usually done for children.
• Exercise-induced asthma (EIA) is a condition of
respiratory difficulty that is triggered by
aerobic exercise and lasts several minutes.
• A treadmill or stationary bicycle

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 HEAMATOLOGIC AND SPUTUM
TESTS
• Blood test are not highly significant.
• Total serum IgE and that specific for allergen
RAST.
• Hyperesinophillia (>0.4 *10^9/L).
• Crush man spirals as an epithelial remnant.

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 SKIN AND ALLERGEN PROVACATION TESTS
• The purpose of these tests are to identify
the allergen for prevention of another
attack(Avoidance of the allergen).
• Common allergens identified are:
• Environmental like (dustmites, grass
pollens).
• Usually associated with other atopic Wheal and flare reaction

disorders like allergic rhinitis

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 IMAGING
• Imaging studys have not big role in diagnosing
asthma.
• It shows hyperinflated lung as an obstructive
lung disease, Or pneumothorax.
• Lung shadowing indicates pneumonia, or
bronchopulmonary asperillosis.
• CT may shows areas of bronchiectasis or
bronchial wall theckening.
• All these are not diagnostic to asthma.

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 AIRWAY RESPONSIVENESS
• This test indicates that the patient have airway
hyperresponsiveness.(Low concentration of the
agent initiate high response).
• Rarely useful in clinical practice.
• Done by using methacholine or histamine and
calculate the concentration that decrease FEV1
by 20%. PC20 FEV1
• Used for differential diagnosis of chronic cough
with normal pulmonary function tests.

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 Exhaled Nitric oxide
• Exhaled nitric oxide (NO), a measure of airway
inflammation and an index of corticosteroid
response, is used in children as a test for the
efficacy of corticosteroids.

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 DIFFERENTIAL DIAGNOSIS
• It is not difficult to differentiate asthma from other
conditions that cause wheezing and dyspnea like (tumor
or bronchpulmonary dysplasia, laryngeal edema).
• Diagnosis of these cases is by flow volume loop which
shows a reduction in inspiratory as well as expiratory
flow while in asthma only expiratory.
• Bronchoscopy demonstrate the site of narrowing.
• Persistent wheezing in specific area of the chest indicate
foreign body obstruction.
• Eosinophilic pneumonias and systemic vasculitis may be
associated with wheezing.

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 RESOURCES
I. HARRISON’S PRINCIPLES
OF INTERNAL MEDICINE
17th ED.
II. HARRISON’S MANUAL OF
INTERNAL MEDICINE 17th .
III. KUMAR & CLARK CLINICAL
MEDICINE 7th ED.
IV. Medscape , & e-medicine.

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 Review Questions
• What is the most significant and useful tests
for asthma management and monitoring?
• Peak flow meter, and spirometry.

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