Tesis De Alzeimer

aThe British Thoracic Society
Scottish Intercollegiate Guidelines Network

British Guideline on the
Management of Asthma
Quick Reference Guide

May 2008
revised June 2009

A
only to point
 ppliesAudit adults

Applies to all children

Applies to children 5-12

Applies to children under 5

General

British Thoracic Society
Scottish Intercollegiate Guidelines NetworkBritish Guideline on the Management of Asthma
Quick Reference Guide

The College of
Emergency Medicine

May 2008
Revised June 2009

ISBN 978 1 905813 29 2
First published 2003
Revised edition published 2008
Revised edition published 2009
SIGN and the BTS consent to the photocopying of this QRG for the purpose of
implementation in the NHS in England, Wales, Northern Ireland andScotland.
British Thoracic Society,
17 Doughty Street, London WC1N 2PL
www.brit-thoracic.org.uk
Scottish Intercollegiate Guidelines Network
Elliott House, 8 -10 Hillside Crescent, Edinburgh EH7 5EA
www.sign.ac.uk

DIAGNOSIS IN CHILDREN
INITIAL CLINICAL ASSESSMENT

B Focus the initial assessment in children suspected of having asthma on:
ƒ presence of key features in history and examinationƒ careful consideration of alternative diagnoses.

CLINICAL FEATuRES THAT INCREASE THE PROBABILITy OF ASTHMA
ƒ More than one of the following symptoms - wheeze, cough,
difficulty breathing, chest tightness - particularly if these are
frequent and recurrent; are worse at night and in the early morning;
occur in response to, or are worse after, exercise or other triggers,
such as exposureto pets; cold or damp air, or with emotions or
laughter; or occur apart from colds
ƒ Personal history of atopic disorder
ƒ Family history of atopic disorder and/or asthma
ƒ Widespread wheeze heard on auscultation
ƒ History of improvement in symptoms or lung function in response
to adequate therapy.
CLINICAL FEATuRES THAT LOWER THE PROBABILITy OF ASTHMA
Symptoms with colds only, with nointerval symptoms
Isolated cough in the absence of wheeze or difficulty breathing
History of moist cough
Prominent dizziness, light-headedness, peripheral tingling
Repeatedly normal physical examination of chest when
symptomatic
ƒ Normal peak expiratory flow (PEF) or spirometry when
symptomatic
ƒ No response to a trial of asthma therapy
ƒ Clinical features pointing to alternative diagnosisƒ
ƒ
ƒ
ƒ
ƒ

With a thorough history and examination, a child can usually be classed into one of three groups:
ƒ high probability – diagnosis of asthma likely
ƒ low probability – diagnosis other than asthma likely
ƒ intermediate probability – diagnosis uncertain.

 Record the basis on which a diagnosis of asthma is suspected.

Applies only to adults

Applies to all childrenApplies to children 5-12

Applies to children under 5

General

1

DIAGNOSIS IN CHILDREN
HIGH PROBABILITy OF ASTHMA

 In children with a high probability of asthma:
ƒ start a trial of treatment
ƒ review and assess response
ƒ reserve further testing for those with a poor response.
LOW PROBABILITy OF ASTHMA

 In children with a low probability of asthma consider more detailedinvestigation and specialist
referral.

INTERMEDIATE PROBABILITy OF ASTHMA

 In children with an intermediate probability of asthma who can perform spirometry and have
evidence of airways obstruction, assess the change in FEV1 or PEF in response to an inhaled
bronchodilator (reversibility) and/or the response to a trial of treatment for a specified period:

ƒ if there is significantreversibility, or if a treatment trial is beneficial, a diagnosis of asthma is
probable. Continue to treat as asthma, but aim to find the minimum effective dose of therapy.
At a later point, consider a trial of reduction, or withdrawal, of treatment.
ƒ if there is no significant reversibility, and treatment trial is not beneficial, consider tests for
alternative conditions.

C In children with an...