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Review
. 2009 Nov 10;181(10):E210-20.
doi: 10.1503/cmaj.080006. Epub 2009 Sep 21.

Diagnosis of asthma in adults

Alan G Kaplan  1 , Meyer S Balter, Alan D Bell, Harold Kim, R Andrew McIvor
Affiliations
Review

Diagnosis of asthma in adults

Alan G Kaplan et al. CMAJ. .
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
Spirometry results for a patient with asthma: volume–time curves (A), flow–volume loops (B) and data table (C). Obstruction is indicated by the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (55%); significant reversibility is indicated by the improvement in FEV1 after administration of bronchodilator (0.96 L or 53%). These results are diagnostic for asthma.
Figure 2
Figure 2
Serial recordings of peak expiratory flow (PEF) for a patient with occupational asthma. Measurements made during periods at work and while off work show objective improvement of PEF while off work, particularly after 3–4 days (see lower panel). The asthma was due to inhalation of toluene diisocyanate present in a varnish that the patient used at work (exposure indicated by horizontal bars at top of graph). Arrows indicate use of reliever medication (salbutamol) for asthma symptoms. Reproduced courtesy of Dr. André Cartier and Medical Resource Communications.
Figure 3
Figure 3
Bronchoprovocation challenge testing for occupational asthma for the same patient as depicted in Figure 2. The decrease in forced expiratory volume in 1 second (FEV1) after a 30-minute exposure to toluene diisocyanate (TDI; day B, October 27; rectangles) but not after a 30-minute control exposure to paint thinner (day A, October 21; triangles) indicates a positive result on this specific challenge test, providing further confirmation of the diagnosis of occupational asthma due to toluene diisocyanate. Testing was performed in a single-blind manner, with multiple spirometry measurements over time before and after exposure. For day A, FEV1 = 4.17 L, PC20 (concentration of the provoking agent that causes the FEV1 to drop by 20%) = 1.4. For day B, FEV1 = 4.16 L, PC20 = 0.66. Arrow indicates use of reliever medication (salbutamol). Reproduced courtesy of Dr. André Cartier and Medical Resource Communications.
Figure 4
Figure 4
Diagnostic algorithm for asthma.
See this image and copyright information in PMC

Comment in

  • Diagnosis of asthma.
    D'Urzo AD. D'Urzo AD. CMAJ. 2010 Jan 12;182(1):64. doi: 10.1503/cmaj.110-2010. CMAJ. 2010. PMID: 20064967 Free PMC article. No abstract available.

References

    1. Aaron SD, Vandemheen KL, Boulet LP, et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ. 2008;179:1121–31. - PMC - PubMed
    1. Stanbrook MB, Kaplan A. The error of not measuring asthma. CMAJ. 2008;179:1099–102. - PMC - PubMed
    1. Life and breath: respiratory disease in Canada. Ottawa (ON): Public Health Agency of Canada; 2007. [(accessed 2009 Jul. 24)]. Available: www.phac-aspc.gc.ca/publicat/2007/lbrdc-vsmrc/index-eng.php.
    1. Kaplan A. Systems for the management of respiratory disease in primary care —an international series: Canada. Prim Care Respir J. 2008;17:73–8. - PMC - PubMed
    1. Persons with asthma, by age and sex (1996/1997–2005) Ottawa (ON): Statistics Canada; 2009. [(accessed 2009 Jan. 3)]. Available: www40.statcan.ca/l01/cst01/health49a.htm.

Publication types