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Asthma practical cases

Asthma practical cases. Asthma differential diagnosis - Questions. Asthma practical cases. What is the differential diagnosis in the following cases: 5 years old child with single episode of cough and wheeze in September of the first year at school. Asthma differential diagnosis – answers.

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Asthma practical cases

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  1. Asthma practical cases

  2. Asthma differential diagnosis - Questions Asthma practical cases What is the differential diagnosis in the following cases: • 5 years old child with single episode of cough and wheeze in September of the first year at school.

  3. Asthma differential diagnosis – answers Asthma practical cases What is the differential diagnosis in the following cases: • Acute bronchitis

  4. Asthma differential diagnosis - Questions Asthma practical cases What is the differential diagnosis in the following cases: • 2 ½ years child who developed a fit of coughing during a birthday tea at a friends house

  5. Asthma differential diagnosis – answers Asthma practical cases What is the differential diagnosis in the following cases: • FB

  6. Asthma differential diagnosis - Questions Asthma practical cases What is the differential diagnosis in the following cases: • 55 years lifelong smoker with history of increasing breathlessness on exertion

  7. Asthma differential diagnosis – answers Asthma practical cases What is the differential diagnosis in the following cases: • COPD

  8. PFM case – question Asthma practical cases You take PFM from 20 years old male, height 175 cm • what is his predicted reading? • Over the next 3 days his readings are: • day 1 am=400, pm 550 • day 2 am=410, pm 555 • day 3 am=395, pm 550 • is this abnormal?

  9. PFM case - answer Asthma practical cases • 590 L/min • Abnormal variability 550-400/550=27% 555-410/555=26% 550-395/550=28%

  10. Asthma diagnostic tests - questions Asthma practical cases Choose the most appropriate diagnostic test for the following patients: • 14 years boy who finds he gets breathless when playing football, PFM is normal when come to your clinic

  11. Asthma diagnostic tests - answers Asthma practical cases Choose the most appropriate diagnostic test for the following patients: • Exercise test

  12. Asthma diagnostic tests - questions Asthma practical cases Choose the most appropriate diagnostic test for the following patients: • 35 years old man who presents for the first time, and has PFM of 250 in the clinic

  13. Asthma diagnostic tests - answers Asthma practical cases Choose the most appropriate diagnostic test for the following patients: • Reversibility test

  14. Asthma diagnostic tests - questions Asthma practical cases Choose the most appropriate diagnostic test for the following patients: • 60 years old heavy smoker who has not responded to high dose B2 agonists

  15. Asthma diagnostic tests - answers Asthma practical cases Choose the most appropriate diagnostic test for the following patients: • Steroid trial

  16. Asthma diagnostic tests - questions Asthma practical cases Choose the most appropriate diagnostic test for the following patients: • 23 years old who had worse symptoms since starting his job at a bakery

  17. Asthma diagnostic tests - answers Asthma practical cases Choose the most appropriate diagnostic test for the following patients: • Serial PEF for 2w

  18. Delivery systems case - questions Asthma practical cases Choose the appropriate delivery systems in the followings (one or more): B2 agonists for18 month baby?

  19. Delivery systems case - answers Asthma practical cases Spacer device with facemask

  20. Delivery systems case - questions Asthma practical cases Choose the appropriate delivery systems in the followings (one or more): B2 agonist for 18 year who is unable to use MDIs correctly?

  21. Delivery systems case - answers Asthma practical cases DPI/breathe actuated MDI

  22. Delivery systems case - questions Asthma practical cases Choose the appropriate delivery systems in the followings (one or more): B2 agonist for 27 year old, successfully controlled since childhood on MDI

  23. Delivery systems case - answers Asthma practical cases MDI

  24. Delivery systems case - questions Asthma practical cases Choose the appropriate delivery systems in the followings (one or more): B2 stimulant reversibility testing in the clinic

  25. Delivery systems case - answers Asthma practical cases Spacer + MDI or nebulizer

  26. Delivery systems case - questions Asthma practical cases Choose the appropriate delivery systems in the followings (one or more): B2 stimulant in acute sever asthma

  27. Delivery systems case - answers Asthma practical cases Spacer/nebulizer

  28. Asthma practical cases JAMES CASE James is 18 month old and is presenting for the first time with intermittent cough and wheeze, the history suggest URTI which is possible trigger. In the clinic his symptoms relieved by high dose ventoline via LVS A- If ventoline via LVS had not produce response what you will do?

  29. Asthma practical cases JAMES CASE - answers Send to hospital

  30. Asthma practical cases JAMES CASE James is 18 month old and is presenting for the first time with intermittent cough and wheeze, the history suggest URTI which is possible trigger. In the clinic his symptoms relieved by high dose ventoline via LVS B- His mother is anxious, asks you is it asthma? How do you reply?

  31. Asthma practical cases JAMES CASE - answers Yes it may be asthma, but it can be difficult to be sure at this age because there is no special test can be done, viral infections can cause wheezing in young children. This effect often improve as child get older

  32. Asthma practical cases JAMES CASE James is 18 month old and is presenting for the first time with intermittent cough and wheeze, the history suggest URTI which is possible trigger. In the clinic his symptoms relieved by high dose ventoline via LVS C. What treatment do you recommend?

  33. Asthma practical cases JAMES CASE - answers High dose inhaled bronchodilator + rescue PO Prednisolone to gain rapid control (10 mg up to 3 days)

  34. Asthma practical cases JAMES CASE James is 18 month old and is presenting for the first time with intermittent cough and wheeze, the history suggest URTI which is possible trigger. In the clinic his symptoms relieved by high dose ventoline via LVS D. What inhaler system is appropriate?

  35. Asthma practical cases JAMES CASE – answers LVS + mask if necessary eg volumatic/nebuhaler

  36. Asthma practical cases JAMES CASE James is 18 month old and is presenting for the first time with intermittent cough and wheeze, the history suggest URTI which is possible trigger. In the clinic his symptoms relieved by high dose ventoline via LVS E. How you will respond to James mother questions? • (will he grow out of it)? • I think the dog make him wheeze, should we get rid of the dog? 3. Can we test to see what's he is allergic to?

  37. Asthma practical cases JAMES CASE – answers E- my response will be: • Not all children “grow out of asthma”. Some improves as they get older and they may have periods when they have no symptoms. However asthma can recur at any time because its variable disease • Wait and see. It should be possible to control symptoms, without getting rid of the dog. Removing a pet may cause more distress. Give general advice on keeping the dog out of the bedroom etc • SPT may be unreliable at this age. It will not affect choice of the treatment. Good history may pinpoint the specific allergen. Invasive procedures in children should be avoided if possible

  38. Asthma practical cases JENNY CASE Jenny is 7 years old and has asthma. She has recently had an asthma attack and was admitted to hospital. She is about to start a new school, and her mother is worried about school attendance. Jenny is worried in case she has another asthma attack and she will not have access to her inhalers • What treatment does jenny need? What is an appropriate dose for jenny?

  39. Asthma practical cases JENNY CASE – answers Inhaled steroids 100mcg/twice/day - maximum 400mcg/day

  40. Asthma practical cases JENNY CASE Jenny is 7 years old and has asthma. She has recently had an asthma attack and was admitted to hospital. She is about to start a new school, and her mother is worried about school attendance. Jenny is worried in case she has another asthma attack and she will not have access to her inhalers B. What inhaler deliver system is suitable for jenny?

  41. Asthma practical cases JENNY CASE – answers LVS or DPI

  42. Asthma practical cases JENNY CASE Jenny is 7 years old and has asthma. She has recently had an asthma attack and was admitted to hospital. She is about to start a new school, and her mother is worried about school attendance. Jenny is worried in case she has another asthma attack and she will not have access to her inhalers C. Give 2 advantages, 2 disadvantages of starting PEF monitoring

  43. Asthma practical cases JENNY CASE – answers PEF monitoring gives a regular objective indication of asthma control. It can demonstrate a response to treatment. If technique is poor the measurement is unreliable. Regular PEF monitoring can become a tedious chore for many children and is often forgotten

  44. Asthma practical cases JENNY CASE Jenny's mother is concerned by treatment prescribed. You spend time reassuring her. At jenny's next appointment 2 weeks later, you find that her PEF is still below her previous best and her symptoms persist D.Suggest 2 reasons why the treatment has not been successful

  45. Asthma practical cases JENNY CASE – answers Poor inhaler technique dosage and medication not taken as prescribed

  46. Asthma practical cases JENNY CASE Jenny's mother is concerned by treatment prescribed. You spend time reassuring her. At jenny's next appointment 2 weeks later, you find that her PEF is still below her previous best and her symptoms persist E.Give 2 advantages, disadvantages of inhaled steroids

  47. Asthma practical cases JENNY CASE – answers Effective anti-inflammatory treatment twice/day delivered directly to lung etc. oral candidiasis, dysphonia (parents sometimes don’t accept)

  48. Asthma practical cases EDNA CASE Edna is 70 years old ex-smoker with chronic bronchitis. She was always chesty as a child. Her breathlessness and cough are worse in cold air and after URTI. PEF is 200L/minute. Twenty minutes after 400mcg of inhaled ventoline there is no change • what further tests do you consider? Give dosage where drugs are used

  49. Asthma practical cases EDNA CASE - answers • Higher dose up to 2.5mg salbutamol (or equivalent via nebulizer, detailed LFT, oral steroid trial 30mg/day/2weeks

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