Asthma is a common disease affecting about 5% of the population and is characterised by being a reversible obstructive airways disease: performing a reversibility test is one method of diagnosis.

Equipment

Aims

Procedure

  1. Welcome and check identity of patient.
  2. Check source of referral (if self, will need examination first including chest examination if competent)
  3. Explain procedure and gain informed consent
  4. Take initial Peak Flow (PEF) measurement - best of 3 good blows. Give salbutamol through appropriate device.
  5. Take history of presenting complaint and attributes.
  6. History of associated features - allergies, drugs, eczema etc.
  7. Family history of asthma and allergies
  8. Lifestyle - smoking, pets, environmental factors.
  9. Take height, note age and calculate predicted PEF value.
  10. Discuss health issues - smoking, environmental factors etc
  11. If 15 - 20 mins since salbutamol, take 2nd PEF measurement
  12. Calculate percentage reversibility - Difference between 1st & 2nd PEF X 100 1st PEF measurement
  13. If less than 15%, consider other causes eg URTI; COPD; cardiac; anaemia; cystic fibrosis; TB; malignancy etc.
  14. Consider exercise test, home monitoring or referral.
  15. If asthma (15% or more reversibility) outline management plan, commence treatment and follow up in 3-4 weeks time to check effectiveness of Rx, inhaler technique, education, self management plan, management of acute exacerbation.
  16. Update computer.

References