- \n
- Has the patient had an attack, or recurrent attacks of wheezing?<\/li>\n\n\n\n
- Does the patient have a troublesome cough at night?<\/li>\n\n\n\n
- Does the patient have a wheeze or cough after exercise?<\/li>\n\n\n\n
- Does the patient have wheeze, chest tightness, or cough after exposure to airborne allergens or pollution?<\/li>\n\n\n\n
- Do the patient’s colds go to the chest or take more than 10 days to clear up?<\/li>\n\n\n\n
- Are the symptoms improved by appropriate anti-asthma treatment<\/li>\n<\/ul>\n\n\n\n
How to diagnose asthma<\/h4>\n\n\n\n
Consider the diagnosis if the patient has 1 or more of the following;<\/strong>
Symptoms <\/strong><\/p>\n\n\n\n- \n
- Wheeze<\/li>\n\n\n\n
- SOB<\/li>\n\n\n\n
- Chest tightness<\/li>\n\n\n\n
- Cough<\/li>\n<\/ul>\n\n\n\n
Signs<\/strong><\/p>\n\n\n\n
- \n
- None (common)<\/li>\n\n\n\n
- Wheeze<\/li>\n\n\n\n
- Tachypnoea<\/li>\n<\/ul>\n\n\n\n
<\/p>\n\n\n\n
Helpful additional information<\/strong><\/p>\n\n\n\n
- \n
- Symptoms worse at night and\/or early morning<\/li>\n\n\n\n
- Personal or family history of asthma or atopy<\/li>\n\n\n\n
- History of worsening after use of NSAIDs or \u03b2 blockers <\/li>\n\n\n\n
- Recognised triggers- e.g. allergens, cold air, exercise<\/li>\n<\/ul>\n\n\n\n
Objective measurements that can be performed in primary care<\/strong><\/p>\n\n\n\n
- \n
- 20% diurnal variation on 3 or more days in a week for 2 weeks on PEF diary
or
<\/li>\n\n\n\n - FEV1 \u2265 15% (and 200mls) increase after short acting \u03b22 agonist (e.g. Salbutamol 400mcg by pMDI + spacer or 2.5mg by nebuliser)
or
<\/li>\n\n\n\n - FEV1 \u2265 15% (and 200mls) increase after trial oral steroids (prednisolone 40mg\/day for 14 days)<\/li>\n<\/ul>\n\n\n\n
Using FEV1 or PEF as a response to treatment is of limited value in patients with near\/normal lung function. Assess symptomatic response to treatment using a validated tool e.g. Asthma Control Test<\/p>\n\n\n\n
- <\/ul>\n
- Diagnosis unclear or in doubt<\/li>\n\n\n\n
- Spirometry or PEF not appropriate to clinical picture<\/li>\n\n\n\n
- Suspected occupational asthma- refer Dr Reid<\/li>\n\n\n\n
- Patients who remain symptomatic and\/or have impaired lung function and\/or frequent exacerbations despite treatment at Step 4 BTS\/SIGN Guidelines<\/li>\n\n\n\n
- Previous life-threatening or near-fatal attack (How to recognise patients at-risk of near-fatal asthma<\/a>)<\/li>\n<\/ul>\n\n\n\n
Who not to refer:<\/h4>\n\n\n\n
- \n
- Mild intermittent, or mild to moderate persistent asthma who are well controlled unless any features documented above<\/li>\n<\/ul>\n\n\n\n
How to refer:<\/h4>\n\n\n\n
- \n
- Use Gateway to refer to these services<\/li>\n\n\n\n
- Dictation Checklist<\/a><\/li>\n\n\n\n
- FEV1 or PEF if spirometry not available<\/li>\n\n\n\n
- assessment of adherence (prescription records for asthma medications over past 12 months)<\/li>\n\n\n\n
- CXR<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n
Primary Care Management<\/span><\/a><\/span><\/div>\nFactors contributing to difficult to control asthma<\/h4>\n\n\n\n
1. Non adherence<\/strong><\/p>\n\n\n\n
2. Aggravating factors<\/strong><\/p>\n\n\n\n
- \n
- smoking<\/li>\n\n\n\n
- obesity<\/li>\n\n\n\n
- ongoing allergen exposure<\/li>\n<\/ul>\n\n\n\n
3. Comorbidities<\/strong><\/p>\n\n\n\n
- \n
- psychological factors<\/li>\n\n\n\n
- rhinosinusitis<\/li>\n\n\n\n
- sleep apnoea<\/li>\n\n\n\n
- bronchiectasis<\/li>\n<\/ul>\n\n\n\n
Advice on sub-optimally controlled Asthma<\/h4>\n\n\n\n
- \n
- Clarify diagnosis<\/li>\n\n\n\n
- Search for remedial aggravating factors that may be remedial (see notes below)<\/li>\n\n\n\n
- Establish adequate inhaler technique<\/li>\n\n\n\n
- Establish adherence to therapy<\/li>\n\n\n\n
- Consider changing pharmacotherapy appropriate to BTS strategy: figure 4 Stepwise Management of Asthma (see below)<\/li>\n\n\n\n
- Refer specialist advice.<\/li>\n<\/ol>\n\n\n\n
![\"BTS](\"\/files\/sites\/2\/Respiratory-Adult-Asthma-Stepwise-Pharmacological-Management-Updated-Image.jpeg\")
Image Courtesy: HIS SIGN 158 Guidance qrg158.pdf (sign.ac.uk)<\/a><\/figcaption><\/figure>\n<\/div><\/div><\/div>\n\n\n\n Resources and Links<\/span><\/a><\/span><\/div>\n- \n
- Lothian COPD Guidance April 2018 v0 4 Combined<\/a><\/li>\n\n\n\n
- National Institute for Health and Care Excellence (NICE)<\/a><\/li>\n\n\n\n
- Scottish Intercollegiate Guidelines Network (SIGN)<\/a><\/li>\n\n\n\n
- Asthma Exacerbations of Asthma<\/a><\/li>\n\n\n\n
- Asthma Pharmacotherapy<\/a><\/li>\n\n\n\n
- Asthma Specific Management Problems<\/a><\/li>\n\n\n\n
- Asthma Complementary Therapies<\/a><\/li>\n<\/ul>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
Services RIE: Dr Tracey BradshawWGH: Dr Peter Reid St John’s: Dr Donald Noble Diagnosis of asthma When to consider a diagnosis of asthma; How to diagnose asthma Consider the diagnosis if the patient has 1 or more of the following;Symptoms Signs Helpful additional information Objective measurements that can be performed in primary care Using FEV1 or<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4381,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[590],"class_list":["post-3714","page","type-page","status-publish","hentry","category-asthma"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" Asthma<\/a>","rttpg_excerpt":"Services RIE: Dr Tracey BradshawWGH: Dr Peter Reid St John’s: Dr Donald Noble Diagnosis of asthma When to consider a diagnosis of asthma; How to diagnose asthma Consider the diagnosis if the patient has 1 or more of the following;Symptoms Signs Helpful additional information Objective measurements that can be performed in primary care Using FEV1 or","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3714","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3714"}],"version-history":[{"count":13,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3714\/revisions"}],"predecessor-version":[{"id":20275,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3714\/revisions\/20275"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4381"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3714"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3714"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
- National Institute for Health and Care Excellence (NICE)<\/a><\/li>\n\n\n\n
- Lothian COPD Guidance April 2018 v0 4 Combined<\/a><\/li>\n\n\n\n
- Mild intermittent, or mild to moderate persistent asthma who are well controlled unless any features documented above<\/li>\n<\/ul>\n\n\n\n
Referral Guidelines<\/span><\/a><\/span><\/div>\nWho to refer:<\/h4>\n\n\n\n
- \n
- 20% diurnal variation on 3 or more days in a week for 2 weeks on PEF diary