Diagnostic

Question 1

Définition asthme

Answer 1

• Heterogeneous disease (chronic airway inflammation)
• History of respiratory symptoms : wheeze, shortness of breath, chest tightness and cough, that vary over time and in intensity
  + variable expiratory airflow limitation.

Question 2

Phénotypes (7)

Answer 2

• Allergic asthma: often commences in childhood and +/- past and/or family history of allergic disease (eczema, rhinitis, or food or drug allergy).
• Non-allergic asthma: cellular profile of the sputum of these patients may be neutrophilic, eosinophilic or contain only a few inflammatory cells (paucigranulocytic). often lesser short-term response to ICS.
• Cough variant asthma and cough predominant asthma : variable airflow limitation may be absent apart from during bronchial provocation testing. Some patients subsequently also develop wheezing and bronchodilator responsiveness.
• Adult-onset (late-onset) asthma: women++, often non-allergic, often require higher doses of ICS or are relatively refractory to corticosteroid treatment.
• Occupational asthma : should be ruled out in patients presenting with adult-onset asthma
• Asthma with persistent airflow limitation: some patients with long-standing asthma develop airflow limitation that is persistent or incompletely reversible (see p.29).
• Asthma with obesity: different pattern of airway inflammation, with little eosinophilic inflammation

Question 3

Méthodes évaluation variabilité dans l’asthme (adulte/enfant) (5)

Answer 3

• Test BD : 10-15min ap 200-400µg Salbutamol/Albutérol
• Variabilité du DEP (2/j) sur 2 semaines
• Majoration fonction respi après 4 semaines de traitement
• Test de provocation
• Variation entre visites

Question 4

Test BD / Majoration fonction respi après 4 semaines de traitement / Variation entre visites

Answer 4

• Adulte : VEMS ou CVF ≥ 12% et ≥ 200ml p/r baseline ou mieux si ≥ 15% et 400ml
  ou DEP ≥ 20%
• Enfant : VEMS ≥ 1% ou DEP ≥15%

Question 5

Variabilité du DEP (2/j) sur 2 semaines

Answer 5

• Adults: diurnal variability >10%
• Children: diurnal variability >13%
• = (day’s highest minus day’s lowest) divided by (mean of day’s highest and lowest), averaged over two weeks

Question 6

Délais d’arrêt des BD avant Test BD ?

Answer 6

• Short-acting beta2 agonists: ≥4 hours;
• Formoterol, Salmeterol: 24 hours;
• Indacaterol, Vilanterol: 36 hours;
• Tiotropium, Umeclidinium, Aclidinium, Glycopyrronium: 36–48 hours

Question 7

Test de provocation a-t-il une bonne Sp ou Se ?

Answer 7

• Bonne Se mais faible Sp : test (+) à la métacholine se retrouve pour : allergic rhinitis, cystic fibrosis, bronchopulmonary dysplasia and COPD.
• Bonne VPN

Question 8

Test de provocation positif :
- Métacholine ?
- Hyperventilation, hypertonic saline ou mannitol ?
- Excercice ?

Answer 8

• Adults: Fall from baseline in FEV1 of
• Metacholine : ≥20%
• Hyperventilation, hypertonic saline or mannitol challenge: ≥15%
• Standardized exercise challenge >10% and >200 mL - Children: fall from baseline in FEV1 of :
• Standardized exercise challenge >12% predicted (or fall in PEF† >15%).
• If FEV1 decreases during a challenge test, check that FEV1/FVC ratio has also decreased, since incomplete inhalation, e.g., due to inducible laryngeal obstruction or poor effort, can result in a false reduction in FEV1.