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Second Expert Panel on the Management of Asthma........viiNational Asthma Education and Prevention ProgramCoordinating Committee....................................................ixNational Asthma Education and Prevention ProgramScience Base Committee......................................................xPREFACE..........................................................................xi
INTRODUCTION.....................................................1
METHODSUSED TO DEVELOP THISREPORT...........2OVERVIEW OF THE REPORT........................................3Pathogenesis and Definition...........................................3Component 1: Measures of Assessmentand Monitoring...........................................................3Initial Assessment and Diagnosis of Asthma................3Periodic Assessment and Monitoring...........................4Component 2:Control of Factors Contributing toAsthma Severity..........................................................4Component 3: Pharmacologic Therapy.........................4Component 4: Education for a Partnershipin Asthma Care...........................................................5Box 1. Major Events in the Development of EPR-2...........3REFERENCES....................................................................5
PATHOGENESIS AND DEFINITION......................7
Key Points..........................................................................7Differences From 1991 Expert Panel Report.......................7AIRWAY PATHOLOGY AND ASTHMA.........................8Child-Onset Asthma....................................................10Adult-Onset Asthma....................................................10RELATIONSHIP OF AIRWAY INFLAMMATIONAND LUNG FUNCTION...............................................10Airway Hyperresponsiveness........................................10Airflow Obstruction.....................................................11RELEVANCE OF CHRONIC AIRWAYINFLAMMATION TO ASTHMA THERAPY.................11Figure 1. Mechanisms Underlying the Definition ofAsthma..........................................................................8Figure 2. Cellular Mechanisms Involved in AirwayInflammation.................................................................9REFERENCES..................................................................12
COMPONENT 1:MEASURES OF ASSESSMENTAND MONITORING
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INITIAL ASSESSMENT ANDDIAGNOSIS OF ASTHMA......................................15
Key Points........................................................................15Differences From 1991 Expert Panel Report.....................15MEDICAL HISTORY......................................................17PHYSICAL EXAMINATION..........................................17PULMONARY FUNCTION TESTING(SPIROMETRY)...........................................................17ADDITIONAL STUDIES................................................19DIFFERENTIAL DIAGNOSISOF ASTHMA.................22GENERAL GUIDELINESFOR REFERRAL TO ANASTHMA SPECIALIST....................................................23Box 1. Key Indicators for Considering a Diagnosisof Asthma....................................................................16Box 2. Importance of Spirometry in Asthma Diagnosis...20Figure 1-1. Suggested Items for Medical History.............18Figure 1-2. Sample Questions for the Diagnosisand Initial Assessment of Asthma.................................19Figure 1-3. Classification of Asthma Severity...................20Figure 1-4a. Sample Spirometry Volume Time andFlow Volume Curves.....................................................21Figure 1-4b. Report of Spirometry Findings Pre andPost Bronchodilator......................................................21Figure 1-5. Differential Diagnostic Possibilitiesfor Asthma...................................................................22REFERENCES..................................................................23
CONTENTS
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