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Others exercise viral infection smoke changes in temperature chemicals drugs (NSAIDs, ß-blockers)
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ASTHMA - THE CLINICAL SYNDROMEASTHMA - THE CLINICAL SYNDROME
• Episodic symptoms and signsEpisodic symptoms and signs• Diurinal variability – nocturnal/early morning Diurinal variability – nocturnal/early morning • Non-productive cough, wheezeNon-productive cough, wheeze• TriggersTriggers• Associated atopy ( rhinitis , conjunctivitis, eczema)Associated atopy ( rhinitis , conjunctivitis, eczema)• Family history of asthmaFamily history of asthma• Wheezing due to turbulent airflowWheezing due to turbulent airflow
DIAGNOSIS OF ASTHMADIAGNOSIS OF ASTHMA
• History and examinationHistory and examination• Diurinal variation of peak flow rateDiurinal variation of peak flow rate• Reduced forced expiratory ratioReduced forced expiratory ratio
(FEV(FEV11/FVC < 75%)/FVC < 75%)• Reversibility to inh. salbutamol (>15%)Reversibility to inh. salbutamol (>15%)• Provocation testing Provocation testing bronchospasm bronchospasm
Stopping smoking arrests further decline in lung volumeStopping smoking arrests further decline in lung volume
Asthma vs COPD• Non smokers • Allergic• Early or late onset• Intermittent symptoms• Non productive cough• Non progressive • Eosinophilic inflammation• Diurnal variability• Good corticosteroid response• Good bronchodilator response• Preserved FVC and TLCO• Normal gas exchange
• Smokers• Non allergic• Late onset• Chronic symptoms• Productive cough• Progressive decline• Neutrophilic inflammation • No diurnal variability• Poor corticosteroid response• Poor bronchodilator response• Reduced FVC and TLCO• Impaired gas exchange