Asthma severity assessment

Using the data provided, assess the severity of the asthma. The severity of Ms RJ s asthma is assessed in Table A3.10. 

Worsening or acute asthma can be a life-threatening situation, and appropriate outcomes require rapid assessment and appropriate intensification of therapy. Mortality associated with asthma exacerbations is usually related to an inappropriate assessment of the severity of the exacerbation resulting in insufficient treatment or referral for medical care.12 The goals... 

Starting therapy at home allows for rapid initiation and early assessment of response. Patients should follow their written action plan as symptoms intensify or lung function deteriorates. An algorithm for the initial treatment of an asthma exacerbation at home is shown in Fig. 11-2. Based on the initial response to P2-agonist therapy, the severity of the exacerbation can be assessed, and treatment can be appropriately intensified.1... 

Assess the patient s symptoms and status (i.e., inpatient, outpatient, or intubated) to determine the type of pneumonia and comorbid conditions. Does the patient have moderate to severe asthma, COPD, or emphysema or is a current smoker ... 

Spirometric tests are recommended at initial assessment, after treatment is initiated, and then every 1 to 2 years. Peak flow monitoring is recommended in moderate to severe persistent asthma. 

After elaborate guidelines for the diagnosis and assessment of the severity of disease, which will not be covered in this summary, the ARIA report also gives detailed recommendations for the management of rhinitis and to some extent asthma, which in contrast to former reports are evidence-based. The paper... 

A broad spectrum of diseases in children are known (or suspected) to be associated with unhealthy environments. For much of the world, traditional environmental health hazards continue to remain the primary source of ill-health. These include lack of adequate nutrition, poor sanitation, contaminated water, rampant disease vectors (e.g. mosquitoes and malaria), and unsafe waste disposal. In addition, rapid globalization and industrialization coupled with unsustainable patterns of production and consumption have released large quantities of chemical substances into the environment. Although the term environmental exposure can encompass a variety of factors, the focus of this document is specifically on environmental chemical exposures. Most of these substances have not been assessed for potential toxicity to children, nor have the most vulnerable subpopulations of children been identified. The incidence of a number of important paediatric diseases and disorders (e.g. asthma, neurobehavioural impairment) is increasing in several parts of the world. Although a variety of factors are likely to be involved, this may be due, in part, to the quality of the environment in which children live, grow, and play. 

Using the data provided, assess the severity of the asthma. 

Aldington S and Beasley R (2007) Asthma exacerbations 5 assessment and management of severe asthma in adults in hospital. Thorax 62 447-458. 

The VC in COPD may be greater than the FVC, because of floppy airways. Spirometry does not distinguish between airflow obstruction due to asthma and COPD, but in conjunction with reversibility testing it can do so. FEV can therefore be diagnostic, assess severity and prognosis and monitor progression of disease. 

Q5 Name an additional test which would be useful in assessing the severity of a patient s asthma. 

Patients with acute severe asthma should receive supplemental oxygen therapy to maintain arterial oxygen saturation above 90% (above 95% in pregnant women and patients with heart disease). Significant dehydration should be corrected urine specific gravity may help guide therapy in young children, in whom assessment of hydration status may be difficult. 

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