Tuesday, 26 November 2013

Asthma (Respiratory Disease) – The Diagnosis

Respiratory Disease is defined as medical conditions which affect the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and  muscles breathing , etc,.
I. Asthma 
Asthma is a chronic inflammatory disease affecting the air way of the lung with recurring symptoms, such as wheezing, chest tightness, shortness of breath, and coughing. The disease affects people of all ages, and mostly starts during childhood. In the study of 463,801 children aged 13-14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304,796 children, found that for asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia(1). In the United States, approximately, asthma affects 25 million people, 7 million of them are children.
C. Diagnosis and tests
If you are experience some of the above symptoms and if your doctor suspects that you have asthma, after recording your family history and completing the physical exam, the test which your doctor orders include
1. Chest X-Ray 
In the study of the medical records of 58 patients aged 18-40 with the diagnosis of mild to moderate asthmato  assess the value of the chest X-ray in helping to make the diagnosis of asthma at the primary care level, researchers at theHarvard University Health Services, showed that the number of asthmatic patients with CXR+ and SPI – (n = 23) was significantly larger than the number with CXR- and SPI+ (n = 10), which indicates that for mild asthma the chest X-ray may be more sensitive than spirometry even though not as specific(28). Other suggested that the X-ray request was an action not based on sound clinical judgement. Cost savings and a reduction in radiation exposure can be made by eliminating unnecessary chest X-ray requests(29).
2. Spirometry
Spirometry is  a lung (or pulmonary) function test to measure the lung function in studying the air volume and flow rate within the lungs. According to the study by Department of Community Medicine, University of Tromsø the ability of GPs to differentiate between asthma and COPD seems to have considerably improved during the last decade, probably due to the dissemination of spirometry and guidelines for COPD diagnosis(30).
3. Peak Flow Testing –
Peak Flow Testing is a self-assessment to evaluate lung function  The peak expiratory flow (PEF), also known as peak expiratory flow rate (PEFR)  is to measure the airway
4. Impulse oscillometry (IOS)
Impulse oscillometry is a noninvasive and rapid technique requiring only passive cooperation by the patient. Pressure oscillations are applied at the mouth to measure pulmonary resistance and reactance. It is employed by health care professionals to help diagnose pediatric pulmonary diseases such asthma and cystic fibrosis; assess therapeutic responses; and measure airway resistance during provocation testing(31).In the study to to evaluate whether impulse oscillometry, an easy-to-perform technique, can detect asthmatic airway obstruction stage, researchers at the Shanghai Pudong New Area People’s Hospital, found that IOS provides an accurate, reliable, and patient-friendly technique for classifying asthmatic airway obstruction(32).
5. Allergy Tests for Asthma
if you doctor suspects that your asthma may be triggered as a result of an allergic reaction.  Allergy tests may be ordered to determine the exact cause of your allergy and asthma. In the study to determine the predictive value of allergy and pulmonary function tests for the diagnosis of asthma in athletes, showed that positive prick tests were recorded in 44.4% of athletes (in 60.5% of asthmatics, in 95.2% of rhinitics and in 21.0% of nonasthmatic – nonrhinitic subjects).  Skin-tests positivity was not related to the abnormal spirometric data found in individual cases. Provocation tests with bronchodilators or exercise did not appear sensitive enough to diagnose mild forms of asthma in subjects with normal basal spirometric values(33).
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(1) http://www.ncbi.nlm.nih.gov/pubmed/9643741
(29) http://www.ncbi.nlm.nih.gov/pubmed/8311783
(30) http://www.ncbi.nlm.nih.gov/pubmed/22135492
(31) http://www.ncbi.nlm.nih.gov/pubmed/21354020
(32) http://www.ncbi.nlm.nih.gov/pubmed/23189951
(33) http://www.ncbi.nlm.nih.gov/pubmed/17845586

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