Classification and Clinical Diagnosis of Bronchial Asthma :
Classification of Bronchial Asthma :
Asthma can be classified in many ways:-
(A) Usual Classification :
A. On the basis of allergy-
a. Allergic of Extrinsic asthma,
b. Non allergic or Intrinsic asthma.
B. Combination of allergic and non-allergic asthma.
C. Factors relating-
a. Exercise induced,
c. Aspirin sensitive etc.
D. On the basis of periodicity-
E. On the basis of age of onset-
a. Early onset (usually allergic of Extrinsic type)
b. late onset (usually Intrinsic type).
(B) Classification by Naepp, USA.
Another classification used by Nation asthma Education and preventive program NAEPP, USA in the following ways-
1) Intermittent asthma:
In this form of asthma patient remains symptom free in between attack and peak flow meter recording is normal.
2) Persistent asthma:
In this form patient has frequent attack eg, patient has coughing, wheezing or shortness of breath at least > 2 times in a month. There are 3 persistent variety-
a) Mild persistent variety:
Here patient have > 2 times of nocturnal attack, baseline PEFR (peak expiratory flow rate) or FEV1 is usually less than 80% to 65% and also PFT occasionally normal in between attack.
b) Moderate persistent asthma:
Almost daily complain with baseline PEFR < 65%.
c) Severe persistent asthma :
Patient having some degree of dyspnea > 6 months and baseline PEFR < 50%.
iii) Acute exacerbation :
A condition of life threatening attack.
- Mild: Dysponeic but can talk.
- Moderate: Cannot complete a sentence.
- Severe: Severely dyspoenic, restless may be unconscious.
iv) Special variants :
a) Seasonal asthma:
Patients experience asthma only in a particular period of a year. Pollens, moulds are the causative factors. Inhaled corticosteroids, cromlyn sodium are the choice of drugs.
b) Exercise induced asthma:
Patient experience broncho-spasm during the period of exercise. An exercise challenge test can be used to establish the diagnosis.
c) Cough variant asthma:
Esonophilic bronchitis is the other name. This variety present with chronic cough and sputum with eosonophilia.
d) Drug induced asthma:
When drugs like aspirin, b-blocker etc invites broncho-spasm.
e) Pregnancy and asthma :
During pregnancy asthma follows the rule of one third eg. one third become worse, one third improve and one third remain same. The exact mechanism is unknown.
(C) Classification Usually Used By Russian Medical Expertise:
Mirror way classification
- Extrinsic-non extrinsic (intrinsic)
- Immunologic-non immunologic
- Infection -allergic versus Non infection-allergic. etc.
(D) Classification By Grading of Bronchial Asthma (Usually Used In Uk and Australia):
a) Mild Asthma
- Mild episode,
- Not more than one attack in a week
- Response to broncho dilator within 48 hours.
- Working hour or school time usually not lost,
- No sleep disturbance,
b) Moderate Asthma
- Moderate episode,
- More than one attack in a week,
- In between episode cough and wheeze is present frequently,
- Sleep disturbance present,
- Working hour often loss.
c) Severe Asthma
- Severe episode,
- Daily wheezing
- Frequent hospitalization,
- Frequent loss of working hour,
- Sleep disturbance is very common,
- Continuation of broncho dilators + steroids to relief from symptoms.
Difference Points Between Extrinsic And Intrinsic Asthma
In medicine there are three common symptoms-cough, wheeze and respiratory difficulties. However people tell their experiences during their attack commonly as-
- Shortness of breath- Here one person complains that he can not finish his each breath before need another.
- Wheezing- Some one can here whistling noise catching inside the lung.
- Tightness of chest- Some one feels that an elastic band is placed around his chest.
- Cough-A cough is often a sign of asthma. Nocturnal cough is a common symptom of asthma.
It is to be remembered that above common symptoms of asthma patient occurs repeatedly. Therefore history is an important factor. During acute phase following signs and symptoms are present-
Hyperinflation of chest, tachypnea, tachycardia, bronchi, chest recession, use of accessory muscle, agitation, inability to speak, pule us paradoxical, trepoid sitting position etc.
Interpretations: 0-4 = No immediate danger, 5-6= Impending respiratory failure, notify ICU and anesthesia,>7= respiratory failure. (Modified from wood DW, Downes JJ).
Feathers of severity:
- Pulse rate>100,
- Pulse us paradox us,
- Unable to speak in one sentence,
- Peak flow less than 50% of predicted.
Life threatening features:
- Can not speak,
- Central cyanosis,
- Silent chest,
- Unrecordable peak flow.
Different diagnosis of asthma patient-
It is wise to exclude other disease like-
PTB (pulmonary tuberculosis), CCF, recurrent pneumonia, GE reflux disorder, post nasal drip symptom, Bromchiolities, aspergilosis, tropical eosonophilia, foreign body impaction etc.
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