Now, multi-step approach to asthma. Remember,
often times, with asthma, it is not, not present
by itself. When it is present by other issues
and you find other concomitant type
of diseases well things become a little tricky.
Often times your patient with asthma, well
COPD, smoking history. What does a low DLCO
mean to you? Remember diffusion capacity of
your carbon monoxide is measuring how quickly
is that oxygen leaving the alveoli entering?
Good, the pulmonary capillaries. So therefore
if there is increase mucous plug and there is
increase barrier, then please understand that
now, this type of COPD which is what asthma
is right, it comes in umbrella of COPD. Well,
now you have problems. Severe, chronic productive
cough. Cor pulmonale, what does that
mean? There is so much obstruction taking
place that may result in pulmonary hypertension,
therefore, resulting in right-sided heart
failure. Is that cor pulmonale? Yes, it is.
Now, as we move on into further topics, I’ll
give you the exact definition of COPD, asthma
and its symptoms early on, really would not
fit the definition and criteria of COPD so
when we get to that point I’ll show you
how chronic bronchitis, emphysema and asthma
are all going to overlap. Take a look at low
DLCO, smoking history. All of these is suggesting
pretty severe disease. There could
be vocal cord dysfunction.
Now, something that we talked about earlier
which is your loop spirometry is that if there
was vocal cord type of lesion which is, well,
as you’re trying to breathe out say that
there is especially any health care workers, then
you have fixed type of obstruction. What
does fixed obstruction mean to you? It means
that you’re going to have a hard time inspiring
hence a very shortened and curtailed type
of inspiration curve on the bottom half and
you also have a curtailed and shortened type
of exhalation curve, loop spirometry. So,
this would be a good time for you to go back
and take a look at your fixed loop spirometry.
In that particular discussion,
we went ahead and talked about two other types
of loop spirometries, there were three that
were total. We had intrathoracic, extrathoracic.
At this point, focus on vocal cord dysfunction
seen in health care workers. Obstruction of
the vocal cords, not in the airways. And CHF
and PE may present with wheezing as well,
so keep this in mind when you’re dealing
with, well, differentials. COPD, well. DLCO.
Here are the test that you want to do. Vocal
cord dysfunction and CHF and PE, some important
differentials that you want to keep in mind
when dealing with asthma in totality.
Continuing our differential diagnosis, ABPA
stands for Aspergillus bronchopulmonary type
of asthma. This is asthma triggered by Aspergillus,
and what happens? Kind of behaves like your
allergy, what does this mean? Peanut dust,
peanut. Specifically here it’s Aspergillus
and flavus is the organism that you’re thinking
about. Infiltrates on chest x-rays (CXR)
and CT, high Aspergillus specific
IgE and whenever you’re thinking about IgE
then you should thinking about it mounting
upon a mast cell and what are you going to
release? Very good, histamine. And what kind
of effect does histamine have on your bronchi?
Differentials for asthma, keep this in mind.
We talked about COPD, I told you about vocal
cord dysfunction especially health care workers
and then here we’re looking at ABPA. Asthma
can be misdiagnosed of many respiratory
conditions. So a lot of that wheezing that
we’re talking about, keep that in mind that
wheezing can be also found in PE as we’ve