sprint123
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A 18/m with acute onset of nocturnal breathlessness yesterday with wheezes all over his lungs.He has an h/o atopic dermatitis.Now,he presents with no resp distress.NSIM?
A.Methacholine provocative test
B.Spirometry before and after bronchodilator treatment
Please explain
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| Justice
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A.Methacholine provocative test
Option (B) cannot be implemented as the Pt is not symptomatic, and bronchodilators would to nothing...
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| doyoudig
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agree
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| sprint123
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But the answer given in Kaplan Qbook was Spirometry with the use of bronchodilators.I am confused with this concept.
Besides the answer,Can someone explain wat is the NSIM in diagnosis of asthma -in general??
Thanx!
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| charu78
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Hi , I found this from CMDT.
1st step for Diagnosis is Spirometry
Clinicians are able to identify airflow obstruction on examination, but they have limited ability to assess it or to predict whether it is reversible. The evaluation for asthma should therefore include spirometry (FEV1, FVC, FEV1/FVC) before and after the administration of a short-acting bronchodilator
2--
Bronchial provocation testing with histamine or methacholine—or exercise challenge testing—may be useful when asthma is suspected and spirometry is nondiagnostic. Bronchial provocation is not generally recommended if the FEV1 is less than 65% of predicted. A positive test is defined as a decrease in FEV1 of at least 20% at exposure to a dose of 16 mg/mL or less. A negative test has a negative predictive value for asthma of 95%.
For follow up at home patients can keep a PEFR (Peek expiratory Flow rate diary)
PEF monitoring can establish peak flow variability, quantify asthma severity, and provide both the patient and the clinician with objective measurements on which to base treatment decisions
Hope this helps.
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| charu78
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Moreover spirometry is always performed when patients are stable.
You will never see status asthmaticus patient getting spirometry when they are hypoxic.In ER
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| doyoudig
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nice explanation guys!!
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| sprint123
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Thanks Charu!
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