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Asthma in Adult

Brenda Phang Joo Yee 



Group 1 Year 4
Outline
• Diagnosis

• Asthma Self Management

• Asthma Control Assessment

• Follow Up Visit

• Medication

• Acute Exacerbation Management


History Diagnosis Investigation
Diagnosis

History Investigation

4 main symptoms demonstration of


obstructive airflow
reversibility
A. Wheeze
B. Cough
C. Shortness of Breath Spirometry
D. Chest Tightness
History
Investigation

Demonstrate

airway
airflow
obstruction
obstruction
variability
Spirometry Bronchodilator ICS
Reversibility reversibility

An improvement An improvement
A FEV1/FVC ratio of <70% 

in FEV1 of ≥12% in FEV1 of ≥12%
is a positive test for 

AND ≥200 ml AND ≥200 ml 

obstructive airway 

(or PEF >20%)
disease
Self Monitoring

(symptoms &/or PEF)

Written Asthma Action Plan (WAAP)

Regular medical Review

Asthma Self
Management
Written Asthma Action Plan (WAAP)
1) Symptoms Control

Assessment of Asthma
Control

2) Risk Factor for Poor Outcome


1) Symptoms Control

Daytime symptoms >2/week

Night awakening

Reliever use >2/week

Activity limitation

in past 4 weeks
2) Risk Factor for Poor Outcome

Risk for exacerbation

Risk of developing fixed airflow limitation

Risk for medication S/E


Medication
Asthma
Night 
 AEBA requiring
Steps Symptoms/
 Risk Factor
Awakening hospitalisation
Need for SABA

1 <2x/month + - + - + -

2x/month - 

2 or ≥1x/month + - + -
2x/week

3 >2x/week or ≥1x/week + - + ANY

4 >2x/week + ≥1x/week or ANY + ANY

Persistent symptoms and exacerbation despite


5 ANY
good adherence to medication
Acute Exacerbation
Management

(Primary Care)
Hyperlipidemia
Brenda Phang Joo Yee 

Group 1 Year 4
Outline

• Types of hyperlipidemia

• Target Level

• Management
Types of
Hyperlipidemia
Composition/ Etiology

Percentage of (Primary/
Serum Lipids Secondary)
Composition/Percentage
of Serum Lipids
Lipoprotein
structure
• There are four major classes of circulating lipoproteins, each with its
own characteristic protein and lipid composition(cholesterol & TG).
They are chylomicrons, very low-density lipoproteins (VLDL), low-
density lipoproteins (LDL), and high-density lipoproteins (HDL).
TG

TC
Etiology

(Primary/Secondary)
When to consider SECONDARY causes of dyslipidemia:

TC > 7mmol/L TG > 4.5mmol/L High TG



Low HDL-C

Must Exclude Must Exclude


Must Exclude

• Primary hypothyroidism
 Alcoholism


Insulin Resistance
(esp elderly)
State

• Nephrosis
(T2DM, Metabolic
• Cholestatic liver disease
Syndrome)

• Failure to respond to anti-lipid drug


Others • Family hx of DMT2, thyroid disease
• Patients on exogenous steroid/having Cushing’s
syndrome
Diagnosis
In measuring lipid levels:
• A standard lipid profile includes measurement of plasma
or serum TC, LDL-C, HDL-Cholesterol (HDL-C) and
triglycerides (TG).

• LDL-C is usually calculated by the Freidewald equation


which is not valid in the presence of elevated TG (TG >
4.5 mmol/L). In this situation, LDL-C will have to be
measured directly. The method of measurement is not
standardized and thus, this is not routinely performed.
• Both fasting and non-fasting samples may be used for
lipid screening. The difference in the values between a
fasting and non-fasting sample is small and has been
shown to have no impact on CV risk estimation even in
diabetics.
Dyslipidaemia

Specific Lipid
Criteria
Abnormalities

TC >5.2 mmol/L

Male: <1.0 mmol/L



HDL-C
Female: <1.2 mmol/L

TG > 1.7 mmol/L

LDL-C depend on patient’s cardiovascular risk


Framingham General CVD Risk Score
Target Level
Primary target Secondary target

LDL-C level non HDL-C level

depends on CV only used in patient with:


global risk 1. combined hyperlipidaemias
2. diabetes
The amount of CV risk reduction 3. cardio metabolic risk
seen will depend on:
4. chronic kidney disease
• absolute risk of the Very High
individual High CV Risk
CV Risk
• degree of LDL-C lowering
that is achieved
<2.6 mmol/L <3.4 mmol/L

specific goal: 

non HDL-C 0.8 mmol/L higher than
the corresponding LDL-C.
Management
A. Therapeutic Lifestyle
Changes (TLC)
• The recommended total fat intake for healthy adults is between 20 to
25% with an upper limit of 30% of total energy intake.

• The intake of SFA (saturated fat) should not exceed 10% of energy
intake.

• TFA (trans fat) intake should be kept at less than 1% of total energy.

• The duration of exercise for CVD prevention in healthy adults regardless


of age is: at least 150 minutes a week of moderate intensity or 75
minutes a week of vigorous intensity PA or an equivalent combination.

• Smoking should be discouraged and individuals referred to the MQuit


Services.
B. Lipid Modifying Drug
+