Topic:Bronchial asthma. Pleural effusion, tuberculosis, Malabsorption syndrome
Question: 21 year old male has presented to the medicine, OP department. He has complaints of episodes of breathlessness associated with tightness of chest and wheezing since childhood. These episodes of occured commonly during the change of season 1.What is the most probable diagnosis 2.How will you confirm the diagnosis 3.Discuss in short the clinical features and management of the disease.
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- The most probable diagnosis is bronchial asthma.
- The diagnosis can be confirmed by:
- Spirometry showing reversible airflow obstruction (FEV1/FVC <70%, FEV1 improves by >12% after bronchodilator)
- Bronchial challenge test using methacholine showing fall in FEV1 by >20% at a low dose of metacholine (<8mg/ml)
- Peak flow variability >10-15% from morning to evening on most days indicates intermittent asthma.
- Methacholine challenge test: FEV1 falls by >20% at <8 mg/mL of inhaled methacholine confirms hyperresponsiveness.
- Allergy testing if symptoms suggest atopy – Skin prick test or RAST.
- Clinical features of bronchial asthma:
- Recurrent episodes of wheezing, breathlessness, chest tightness
- Triggers include allergens, change in weather, exercise, smoke, infections
- Symptoms variable from daily to occasional episodes
- Physical exam shows diffuse wheeze and prolonged expiration
Management:
- Relievers – Short acting beta agonists for rapid symptom relief as needed.
- Controllers – Low dose ICS form backbone. Add ons like LABA, LTRA, theophylline as per severity.
- Stepwise approach based on symptoms and lung function. Treatment adjusted every 3-6 months.
- Patient education on inhaler technique, written asthma action plan, adherence to treatment.
- Comorbidities appropriately treated like GERD, rhinosinusitis, obesity.
- Vaccines for flu, pneumonia advised.
- Acute severe asthma – Oral steroids, supportive treatment, monitor for respiratory failure.
- Surgery for refractory cases – Sinus surgery, bronchial thermoplasty etc.
- Follow up assessing symptom control, exacerbations, lung function every 1-6 months.
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