DR Medhat MRCP

Diagnosis of BA in adults(British Thoracic Society guidelines 2011) :
High probability of asthma
1. Wheeze, breathlessness, chest tightness
& cough, worse at night/early morning
2. History of atopic disorder
3. Wheeze heard on auscultation
4. Unexplained peripheral blood
eosinophilia
low probability of asthma
1. Prominent dizziness, light-headedness,
peripheral tingling
2. Chronic productive cough in the
absence of wheeze or breathlessness
3. Repeatedly normal physical examination
4. Significant smoking history (i.e. > 20
pack-years)
5. Normal PEF or spirometry when
symptomatic
Starting management is based on this assessment:
High probability Trial of treatment
Intermediate probability Spirometry (PFT)
‣ If FEV1/FVC < 0.7 Trial of treatment.
‣ If FEV1/FVC > 0.7 Other investigation/ consider referal.
400 mcg Salbutamol (ventolin) inh.
If FEV1 improved > 400 ml .
If incoplete response to inhaled salbutamole
Give either inhaled corticosteroids (200
mcg twice daily beclometasone for 6-8
weeks) or oral prednisolone (30 mg once
daily for 14 days)
Significant for diagnosis.
If FEV1 improved > 400ml
low probability
investigate & treat other conditions.