Define asthma.

Assessment-History-Present &past,physical examination--Chest auscultation,breating

pattern etc.(FOCUS ASSESSMENT)

Brief explanation of AMC GUIDE LINES.

Peak flow ppt is ok -No need any changes.

Drug-Group--Action-Purpose of giving asthma patients,how its hepl.No need detail

explanation this much only needed.Modify your ppt based on this comments.

OUTLINE
I. Clinical definition of Asthma
II. Categories of Asthma (AMC classification)
III. Clinical Features of Asthma
IV. Focus assessment in Asthma
a. Initial assessment
a.1 History
a.2 Physical Examination
V. AMC Guidelines
VI. Drug of Choice: Hydrocortisone
VII. Piko Peak Flow Monitoring

Common signs and symptoms of asthma include:

Coughing. Coughing from asthma often is worse at night or early in the morning, making
it hard to sleep.
Wheezing. Wheezing is a whistling or squeaky sound that occurs when you breathe.
Chest tightness. This may feel like something is squeezing or sitting on your chest.
Shortness of breath. Some people who have asthma say they can't catch their breath or
they feel out of breath. You may feel like you can't get air out of your lungs.

I. Clinical definition of Asthma

II. Categories of Asthma (AMC classification)
III. Clinical Features of Asthma
Shortness of breath/Dyspnea
Tightness of chest
Excessive coughing or a cough that keeps you awake at night
Wheezing
IV. Focus assessment in Asthma
a. Initial assessment
1. History

Pattern of occurrence
Onset
Intensity
Duration
Nature
Sputum
Severity
Associated symptoms
Precipitating or aggravating
factors
Family History
Social History

sudden or gradual

b. Physical examination USUAL FINDINGS in ASTHMATIC PATIENT

Inspection
a. General
Appearance
Posturing
Breathing effort
b. Oxygenation : cyanosis
Nails
Skin
Lips
c. Chest wall configuration
Retractions
d. Respiratory effort
Rate and Depth
Breathing pattern
Chest expansion
Auscultation
1. Onset & progession: ACUTE, sudden OR Gradual over a prolonged period or time.
2. Progression the time period over which breathlessness developed.
3. Timing Early morning severe asthma
During the week occupational asthma
Spring atopic asthma
4 .Severity or Grade: How far the patient can walk on the flat without stopping.
How many steps can be climbed without stopping.

Do you feel breathless when washing or dressing.

Do you feel breathless at rest.
5. Variability: Episodic ( intermittent) or persistent. worse at night and early morning
6. AGGREVATING&RELIEVING FACTORS Exercise, cold exposure, Excitement, Drugs.
Focused history taking OSCEs (Data gathering station) Here you will show your medical knowledge
concerning the current specific patient and case. Include:
1. The chief complaint.
2. History of present illness.
3. Past medical and surgical history.
4. Medications and allergies.
5. Family history and social history.
6. Occupational history.

Diagnosis of Asthma
An accurate diagnosis of asthma is based on a combination of medical history, physical examination, and
spirometry [5]. A thorough medical history should include pattern of occurrence; precipitating or
aggravating factors; exacerbation type, severity, and frequency; family and social history; and the
patients own assessment of their illness.
The physical examination should be focused on abnormalities of the nose, throat, upper airway, skin, and
chest [5]. In terms of the latter, hyperexpansion of the thorax, use of accessory muscles, appearance of
hunched shoulders, and chest deformity should increase the suspicion of asthma. Auscultations of
wheezing during normal breathing and/or a prolonged phase of forced exhalation are typical findings
associated with airflow obstruction. However, the NAEPP notes that wheezing may only be heard during
forced exhalation, but this is not a reliable indicator of airflow limitation [5]. Signs of allergic reactions,
such as increased nasal secretion, mucosal swelling, and/or nasal polyps; atopic dermatitis/eczema; or any
other manifestation of an allergic skin condition, should also raise suspicion of asthma [5].
Spirometry, in combination with medical history and physical examination, is essential to establish the
diagnosis of asthma. Spirometry must establish reversible obstructive airflow defined as an increase in
FEV1 of 12% and 200 mL after the administration of a bronchodilator [12]. The Global Initiative for
Asthma (GINA) guidelines advise that most asthma patients will not demonstrate reversibility at every
assessment; therefore, repeat assessments are recommended [12]. Importantly for the differential
diagnosis of asthma and COPD, it should be noted that persistent non-fully reversible airway obstruction,
the classic hallmark of COPD, can also occur in patients with long-standing asthma [13].
The NAEPP provides guidance on establishing the severity of asthma, which is based on 2 components:
impairment and risk of future adverse effects of the condition (such as exacerbations and decreasing lung
function). Both of these domains are based on spirometry, frequency of symptoms and their effect on
normal activity, and response to treatment [5]. Similarly, assessment of asthma control relies on the
monitoring of the effectiveness of interventions to reduce impairment and reduce the risk of future
adverse events [5].

1. Obtain past medical history

S Signs/Symptoms
A Allergies
M Medications
P Past Relevant Medical History
Pattern of occurrence
-Onset & progession: ACUTE, sudden OR Gradual over a prolonged period or time.
- Progression the time period over which breathlessness developed.
*Timing Early morning severe asthma
*During the week occupational asthma
*Spring atopic asthma
L Last occurence (Exacerbation type, severity, and frequency)
Severity or Grade: How far the patient can walk on the flat without stopping.
How many steps can be climbed without stopping.
Do you feel breathless when washing or dressing.
Do you feel breathless at rest.
Variability: Episodic ( intermittent) or persistent. worse at night and early morning
E Events Leading Up To Present Illness
precipitating or aggravating factors
family, social and occupational history
2. Focused physical assessment
Nose
Upper airway
Throat
Chest
3. Use of Peak flow
Frequency of symptoms and their effect on normal activity
Response to treatment

SIGN
Breathlessness
Speaking
Level of
consciousness
Breathing rate
Muscle
retraction

MILD
On walking
Can lie down
Phrases
May be
agitated
Increased
No

MODERATE
On talking
Prefers to sit up
Parts of phrases
Usually agitated
Increased
Usually

SEVERE
On lying down
words
Always agitated
Often >30/min
Often >30/min
Usually

Wheezing
Pulse/min
Peak expiratory
flow after
treatment

Moderate
<100
Over 70%

Strong
100-120
50-70%

Very syrong
>120
<50%; <100/min