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Pulmonary function test in asthma
decreased FEV1
normal or decreased FVC
decreased FEV1/FVC <75%
Reversibility in airway obstruction in asthma
increase >12% and 200ml in FEV1 or <15% and 200ml in FVC after bronchodilation

absence of revesibility does not mean irreversibility
Stuff about PEF meter
has diurinal variation
morning and afternoon after bronchodilation
20% change suggests inadequate controlled asthma
<200 l/min suggests severe airflow obstruction
Bronchial provacation test
use histamine or methacholine
high neg predictive value 95%
positive test- decrease in FEV1 at least 20% at exposure to concentration of <16 mg/ml
Differential diagnosis of asthma
upper airway- vocal cord problems, foreign body, airway edema
lower airway- COPD, bronchiectasis, cystic fibrosis, eosinophilic pneumonia, bronchiolitis obliterans
churg strauss syndrome
conversion disorder
Mild intermittent asthma
symptoms <2 times a week
nighttime symptoms <2 times a month
FEV1 or PEF > 80%
PEF variability < 20%
Mild persistent asthma
symptoms >2 times a week but less than once a day
nighttime symptoms >2 times a month
FEV1 or PEF >80%
PEF variability 20-30%
Moderate persistent asthma
daily symptoms
daily use of B2 agonist
nighttime symptoms >1 time a week
FEV1 or PEF 60-80%
PEF variability >30%
Severe persistent asthma
continual symptoms
limited activity
frequent nighttime symptoms
FEV1 or PEF <60%
PEF variability >30%
Action of theophylline
mucociliary clearance
diaphragmatic contraction
Action of anticholinergic
reverse vagally mediated bronchospasm
decrease mucus gland hypersecretion
good for beta blocker induced bronchospasm
Dose of steroid in asthma exacerbation
mild- 0.5-1 mg/kg/day (40-60mg) for 3-10 days
severe- 1 mg/kg of prednisone equivalent every 6-12 hours for 48 hours or until FEV1 (PEFR) returns to 50% and then reduced to 60-80 mg/day until PEF reaches 70%
Criteria to discharge to home
PEF or FEV1 has returned to >70
minimal symptoms

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