| What does FEV1 stand for in pulmonary function tests? | Forced Expiratory Volume in first second | Components Inadequately controlled (any one) Adequately controlled (all should be present) Daytime symptoms or use of rescue medication More than twice a week Twice or less in a week Night-time symptoms/ awakening Any Any None None Limitation of activities Pulmonary function (if available) FEV1 <80% of predicted or PEF <80% of personal best FEV1 >80% of predicted or PEF >80% of personal best FEV1 Forced Expiratory Volume in first second, PEF Peak Expiratory Flow | 400 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952329_pulmonology_asthma.pdf | Components Inadequately controlled (any one) Adequately controlled (all should be present) Daytime symptoms or use of rescue medication More than twice a week Twice or less in a week Night-time symptoms/ awakening Any Any None None Limitation of activities Pulmonary function (if available) FEV1 <80% of predicted or PEF <80% of personal best FEV1 >80% of predicted or PEF >80% of personal best FEV1 Forced Expiratory Volume in first second, PEF Peak Expiratory Flow | 1 | page=1,block=16 | 0.700 | valid |
| What is the primary method used for diagnosing conditions in the approach described? | Clinical assessment is the mainstay | APPROACH TO DIAGNOSIS • Clinical assessment is the mainstay • Airway obstruction, and bronchodilator reversibility, on spirometry (if available) may support diagnosis • Refer patients for further work-up if diagnosis is in doubt | 24 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952329_pulmonology_asthma.pdf | APPROACH TO DIAGNOSIS • Clinical assessment is the mainstay • Airway obstruction, and bronchodilator reversibility, on spirometry (if available) may support diagnosis • Refer patients for further work-up if diagnosis is in doubt | 1 | page=1,block=12 | 0.700 | valid |
| What does PEF stand for in pulmonary function tests? | Peak Expiratory Flow | Components Inadequately controlled (any one) Adequately controlled (all should be present) Daytime symptoms or use of rescue medication More than twice a week Twice or less in a week Night-time symptoms/ awakening Any Any None None Limitation of activities Pulmonary function (if available) FEV1 <80% of predicted or PEF <80% of personal best FEV1 >80% of predicted or PEF >80% of personal best FEV1 Forced Expiratory Volume in first second, PEF Peak Expiratory Flow | 446 | definition | 0.940 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952329_pulmonology_asthma.pdf | Components Inadequately controlled (any one) Adequately controlled (all should be present) Daytime symptoms or use of rescue medication More than twice a week Twice or less in a week Night-time symptoms/ awakening Any Any None None Limitation of activities Pulmonary function (if available) FEV1 <80% of predicted or PEF <80% of personal best FEV1 >80% of predicted or PEF >80% of personal best FEV1 Forced Expiratory Volume in first second, PEF Peak Expiratory Flow | 1 | page=1,block=16 | 0.700 | valid |
| What nasal symptoms are associated with asthma but not COPD? | Prominent and almost universal None | Course Wheeze Asthma COPD Age of Onset Smoking, other Nasal Symptoms, Atopy Triggers More often in childhood or early adulthood; variable Usually later in life (4th or 5th decade) Episodic Progressive Uncommon Uncommon Common Common Rare Often Often Identified Prominent and almost universal None May or may not be present Family History | 261 | comparison | 0.920 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952329_pulmonology_asthma.pdf | Course Wheeze Asthma COPD Age of Onset Smoking, other Nasal Symptoms, Atopy Triggers More often in childhood or early adulthood; variable Usually later in life (4th or 5th decade) Episodic Progressive Uncommon Uncommon Common Common Rare Often Often Identified Prominent and almost universal None May or may not be present Family History | 1 | page=1,block=44 | 0.700 | valid |
| How does the progression of asthma differ from COPD? | Episodic Progressive | Course Wheeze Asthma COPD Age of Onset Smoking, other Nasal Symptoms, Atopy Triggers More often in childhood or early adulthood; variable Usually later in life (4th or 5th decade) Episodic Progressive Uncommon Uncommon Common Common Rare Often Often Identified Prominent and almost universal None May or may not be present Family History | 180 | comparison | 0.840 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952329_pulmonology_asthma.pdf | Course Wheeze Asthma COPD Age of Onset Smoking, other Nasal Symptoms, Atopy Triggers More often in childhood or early adulthood; variable Usually later in life (4th or 5th decade) Episodic Progressive Uncommon Uncommon Common Common Rare Often Often Identified Prominent and almost universal None May or may not be present Family History | 1 | page=1,block=44 | 0.700 | valid |
| What are some conditions that mimic asthma? | presence of fever, constitutional symptoms, purulent sputum, hemoptysis, focal chest signs on physical examination, foreign body aspiration, abnormal chest radiograph, etc. | TRY AND RULE OUT • Other obstructive airway disorders – see Table 1 for features that favour asthma over COPD • Other mimics – presence of fever, constitutional symptoms, purulent sputum, hemoptysis, focal chest signs on physical examination, foreign body aspiration, abnormal chest radiograph, etc. | 127 | list | 0.780 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952329_pulmonology_asthma.pdf | TRY AND RULE OUT • Other obstructive airway disorders – see Table 1 for features that favour asthma over COPD • Other mimics – presence of fever, constitutional symptoms, purulent sputum, hemoptysis, focal chest signs on physical examination, foreign body aspiration, abnormal chest radiograph, etc. | 1 | page=1,block=3 | 0.700 | valid |
| What are the classic symptoms of asthma? | Recurrent/episodic wheezing • Breathlessness • Cough and/or chest tightness | Classic symptoms • Recurrent/episodic wheezing • Breathlessness • Cough and/or chest tightness Supportive features • History of atopy, family history of asthma, presence of triggers, presence of rhonchi on chest auscultation • No alternative explanation for these symptoms GUIDING PRINCIPLES • Mainstay of pharmacotherapy: Inhaled drugs • Frequency of symptoms determine treatment initiation (see figure 1 for details) • Reassess at 3-4 weeks – good response : in favour of asthma diagnosis • Patient education for compliance, warning signs, triggers, inhaler technique, PEF monitoring • Inhaler technique to be monitored • Follow-up at 4-12 weeks, assess diseases control by clinical parameters (see Table 2) • Step-up or step-down treatment as per level of asthma control (see figure 1) • Follow up three-monthly and modulate treatment as needed • Refer for further evaluation and management if asthma remains poorly controlled WHEN TO SUSPECT EXACERBATION • Suspect if acute symptomatic worsening , or reduction in PEF to below 80% of personal best , while on continued treatment • Take two additional puffs of the inhaler used if symptoms persist, and repeat if needed • If no response after 24 hours, or symptomatic worsening, or further reduction in PEF, contact physician • Physician to assess severity of exacerbation and manage accordingly REFERENCES 1. |
| What supportive features may indicate asthma? | History of atopy, family history of asthma, presence of triggers, presence of rhonchi on chest auscultation | Classic symptoms • Recurrent/episodic wheezing • Breathlessness • Cough and/or chest tightness Supportive features • History of atopy, family history of asthma, presence of triggers, presence of rhonchi on chest auscultation • No alternative explanation for these symptoms GUIDING PRINCIPLES • Mainstay of pharmacotherapy: Inhaled drugs • Frequency of symptoms determine treatment initiation (see figure 1 for details) • Reassess at 3-4 weeks – good response : in favour of asthma diagnosis • Patient education for compliance, warning signs, triggers, inhaler technique, PEF monitoring • Inhaler technique to be monitored • Follow-up at 4-12 weeks, assess diseases control by clinical parameters (see Table 2) • Step-up or step-down treatment as per level of asthma control (see figure 1) • Follow up three-monthly and modulate treatment as needed • Refer for further evaluation and management if asthma remains poorly controlled WHEN TO SUSPECT EXACERBATION • Suspect if acute symptomatic worsening , or reduction in PEF to below 80% of personal best , while on continued treatment • Take two additional puffs of the inhaler used if symptoms persist, and repeat if needed • If no response after 24 hours, or symptomatic worsening, or further reduction in PEF, contact physician • Physician to assess severity of exacerbation and manage accordingly REFERENCES 1. |
| What are the respiratory rate and heart rate thresholds for severe acute asthma? | respiratory rate >30/min, heart rate >110/min | SEVERE ACUTE ASTHMA (PATIENT TO BE ADMITTED) • Inability to complete sentences, agitation, use of accessory muscles, respiratory rate >30/min, heart rate >110/min, pulsus paradoxus >25 mm Hg, silent chest, and/or room air sPo2 <92% • Oxygen supplementation to maintain spO2 92-95% • Nebulized levosalbutamol/ipratropium (1.25 mg/0.5 mg) three doses at 20-minute interval, then 4-6 hourly or as needed • Injection hydrocortisone 200 mg intravenously, then oral prednisolone 0.5 mg/kg daily for five days • Refer if no improvement • Discharge only when symptoms improve, wheezing absent or significantly reduced, heart rate <100 bpm, respiratory rate <30/min, room air sPo2 >94% • Schedule follow-up outpatient visit at one week LIFE-THREATENING EXACERBATION Altered sensorium, orthopnea, cyanosis, paradoxical breathing, hypotension, and/or bradycardia (heart rate <60 bpm) – immediately refer to higher centre with ICU facility | 117 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952329_pulmonology_asthma.pdf | SEVERE ACUTE ASTHMA (PATIENT TO BE ADMITTED) • Inability to complete sentences, agitation, use of accessory muscles, respiratory rate >30/min, heart rate >110/min, pulsus paradoxus >25 mm Hg, silent chest, and/or room air sPo2 <92% • Oxygen supplementation to maintain spO2 92-95% • Nebulized levosalbutamol/ipratropium (1.25 mg/0.5 mg) three doses at 20-minute interval, then 4-6 hourly or as needed • Injection hydrocortisone 200 mg intravenously, then oral prednisolone 0.5 mg/kg daily for five days • Refer if no improvement • Discharge only when symptoms improve, wheezing absent or |
| What is the initial intravenous dose of hydrocortisone for severe acute asthma? | 200 mg intravenously | SEVERE ACUTE ASTHMA (PATIENT TO BE ADMITTED) • Inability to complete sentences, agitation, use of accessory muscles, respiratory rate >30/min, heart rate >110/min, pulsus paradoxus >25 mm Hg, silent chest, and/or room air sPo2 <92% • Oxygen supplementation to maintain spO2 92-95% • Nebulized levosalbutamol/ipratropium (1.25 mg/0.5 mg) three doses at 20-minute interval, then 4-6 hourly or as needed • Injection hydrocortisone 200 mg intravenously, then oral prednisolone 0.5 mg/kg daily for five days • Refer if no improvement • Discharge only when symptoms improve, wheezing absent or significantly reduced, heart rate <100 bpm, respiratory rate <30/min, room air sPo2 >94% • Schedule follow-up outpatient visit at one week LIFE-THREATENING EXACERBATION Altered sensorium, orthopnea, cyanosis, paradoxical breathing, hypotension, and/or bradycardia (heart rate <60 bpm) – immediately refer to higher centre with ICU facility | 428 | factual | 0.490 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952329_pulmonology_asthma.pdf | SEVERE ACUTE ASTHMA (PATIENT TO BE ADMITTED) • Inability to complete sentences, agitation, use of accessory muscles, respiratory rate >30/min, heart rate >110/min, pulsus paradoxus >25 mm Hg, silent chest, and/or room air sPo2 <92% • Oxygen supplementation to maintain spO2 92-95% • Nebulized levosalbutamol/ipratropium (1.25 mg/0.5 mg) three doses at 20-minute interval, then 4-6 hourly or as needed • Injection hydrocortisone 200 mg intravenously, then oral prednisolone 0.5 mg/kg daily for five days • Refer if no improvement • Discharge only when symptoms improve, wheezing absent or |