GINA_At_A_Glance.pdf

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1、GINAAt-A-GlanceAsthmaManagementReferenceREPRODUCEORALTERNOTDO-MATERIAL®COPYRIGHTEDRevised2009GINA2009sourcedocumentsareatwww.ginasthma.org.©2010MedicalCommunicationsResources,Inc.DIAGNOSINGASTHMAAsthmacanoftenbediagnosedonthebasisofapatient’ssymptomsandmedicalhistory(e.g.,seebelow).QuestionstoCon

2、siderintheDiagnosisofAsthma•Hasthepatienthadanattackorrecurrentattacksofwheezing?•Doesthepatienthaveatroublesomecoughatnight?•Doesthepatientwheezeorcoughafterexercise?•Doesthepatientexperiencewheezeing,chesttightness,orcoughafterexposuretoairborneallergensorpollutants?•Dothepatient'scolds“gotothe

3、chest”ortakemorethan10daystoclearup?•Aresymptomsimprovedbyappropriateasthmatreatment?REPRODUCEMeasurementsoflungfunctionprovideanassessmentoftheseverity,ORreversibility,andvariabilityofairflowlimitation,andhelpconfirmthediagnosisofasthma.ALTERSpirometryisthepreferredmethodofmeasuringairflowlimita

4、tionanditsreversibilitytoestablishadiagnosisofasthma.•AnincreaseinFEV1of12%and200mlafteradministrationofaNOTbronchodilatorindicatesreversibleairflowlimitationconsistentwithDOasthma.(However,mostasthmapatientswillnotexhibitreversibilityat-eachassessment,andrepeatedtestingisadvised.)Peakexpiratory

5、flow(PEF)measurementscanbeanimportantaidinbothdiagnosisandmonitoringofasthma.•PEFmeasurementsareideallycomparedtothepatient’sownpreviousMATERIALbestmeasurementsusinghis/herownpeakflowmeter.•Animprovementof60L/min(or20%ofthepre-bronchodilatorPEF)afterinhalationofabronchodilator,ordiurnalvariation

6、inPEFofmorethan20%(withtwice-dailyreadings,morethan10%),suggestsadiagnosisofasthma.Additionaldiagnostictests:COPYRIGHTED•Forpatientswithsymptomsconsistentwithasthma,butnormallungfunction,measurementsofairwayresponsivenesstomethacholine,histamine,directairwaychallengessuchasinhaledmannitol,orexerc

7、isechallengemayhelpestablishadiagnosisofasthma.•SkintestswithallergensormeasurementofspecificIgEinserum:Thepresenceofallergiesincreasestheprobabilityofadiagnosisofasthma,andcanhelptoidentifyriskfactorsthatcauseasthmasy