Asthma diagnosis and interpretation

of spirometry

Paediatric Aboriginal Lung Health:

This is a free training module, available to everyone!

Chronic respiratory disease is prevalent among Aboriginal children but most doctors have never had the opportunity to learn about Aboriginal paediatric lung health or were given the tools to take a respiratory history in a culturally secure way.

This module focuses on the diagnosis of asthma and the use of spirometry to diagnose respiratory disease. This is the second module in a series on Paediatric Aboriginal Lung Health and builds on the first training module which gives health practitioners the skills to engage effectively with Aboriginal parents when it comes to the respiratory health of their children.

This is a free training module, available to everyone!

Chronic respiratory disease is prevalent among Aboriginal children but most doctors have never had the opportunity to learn about Aboriginal paediatric lung health or were given the tools to take a respiratory history in a culturally secure way.

This module focuses on the diagnosis of asthma and the use of spirometry to diagnose respiratory disease. This is the second module in a series on Paediatric Aboriginal Lung Health and builds on the first training module which gives health practitioners the skills to engage effectively with Aboriginal parents when it comes to the respiratory health of their children.

Learning Objectives and Outcomes

Learning Objective:

To remind the user that:

  • culturally secure engagement with Aboriginal parents is essential for communication and to obtain an accurate history
  • chronic wet cough in children is often a sign of protracted bacterial bronchitis or bronchiectasis
  • undertreated protracted bacterial bronchitis can lead to bronchiectasis
  • the management of chronic wet cough i.e. exclude pointers to alternative causes and then treat with the correct antibiotic regimens
  • children should be referred to a specialist if the cough does not resolve after 4 weeks of antibiotics or with recurrent episodes (more than three) episode of PBB
  • follow-up for Aboriginal children hospitalised with chest infections should be arranged
  • 70% of children with bronchiectasis would previously have been misdiagnosed as having asthma, hence it is important to differentiate clearly between asthma and PBB

Learning Outcome:

After completion of this section, the health practitioner should be more aware of their own skill level in:

  • culturally appropriate methods of taking a respiratory history from the parents of Aboriginal children
  • detecting and managing chronic wet cough in children
  • diagnosis and management of PBB
  • when to refer a child with chronic wet cough to a specialist
  • when to arrange follow-up for Aboriginal children hospitalised with chest infections

Learning objective

  • Brief overview of asthma incidence and pathophysiology
  • Overview of the clinical characteristics of asthma
  • Factors that suggest an alternate diagnosis
  • Differential diagnosis of asthma
  • Diagnosis of asthma
  • Special investigations e.g. full blood count, IgE level, RAST testing for aeroallergens
  • Spirometry as a useful tool to diagnose, rule out or remove an incorrect diagnosis of asthma

Learning outcome:

After completion of this section, the health practitioner should:

  • Understand basic asthma pathophysiology and describe how the pathophysiology drives symptoms
  • Identify from medical history in the outpatient setting children who are likely to have asthma
  • Describe how to conduct a physical exam on a child with suspected asthma and identify physical markers of asthma
  • Describe a range of other conditions that typically mimic asthma
  • Identify from history and clinical examination conditions that may mimic asthma or point to an alternative cause of the symptoms
  • Outline when to request special investigations in a patient with asthma-like symptoms, and explain which investigation/s to request

Learning Objectives:

  • Explain why spirometry is useful
  • Discuss the principle of flow limitation
  • Explain how to read a time-volume curve and a flow-volume curve
  • Very briefly explain how spirometry is performed
  • Describe the characteristics of a normal flow-volume loop
  • Describe a scooped out expiratory loop (what it looks like and what it means)
  • Explain reversible small airway obstruction (what it looks like and what it means)
  • Explain fixed small airway obstruction (what it looks like and what it means)
  • Dynamic intrathoracic large airway obstruction (physiology, spirometry appearance)
  • Dynamic extrathoracic large airway obstruction (physiology, spirometry appearance)
  • Examples of dynamic extrathoracic large airway obstruction (VCD)
  • Examples of dynamic intrathoracic large airway obstruction (tracheal stenosis)
  • Fixed large airway obstruction (tracheal stenosis as example)
  • Discuss FVC and low FVC, examples: a) reduced FVC and scooped out expiratory curve; b) fixed scooped out expiratory curve; c) asthma requiring systemic steroids
  • Quality control in spirometry -what a health practitioner should know:
  • Start of the manoeuvre
  • End of the manoeuvre
  • Repeatability
  • Importance of technician’s comments when interpreting spirometry
  • Example of low-quality spirometry or technical issues

Learning Outcomes:

At the completion of the module the health practitioner should:

  • Be able to interpret basic spirometry
    • diagnose reversible and fixed small airway obstruction
    • diagnose intrathoracic large airway obstruction
    • diagnose extrathoracic large airway obstruction
    • diagnose fixed large airway obstruction
    • identify spirometry suggestive of restrictive lung disease
  • Identify common issues in the interpretation of spirometry, and describe appropriate strategies to mitigate those issues
  • Describe the key elements of the technician’s comments in a spirometry, and the role they play in making correct a diagnosis
  • Apply basic quality control when interpreting spirometry

Feedback from our participants on the ‘best aspects’ from the first module

“Loved the way it was laid out, very easy to understand, excellent information.”

“Interactive and well presenting. The information presented is relevant and succinct.”

“Statistics and explanation around cultural barriers for those that don’t work in this environment.”

“Format was easy to follow and engaging. Cultural learning was applicable to all areas of health not just respiratory health.”

“Flowed well, easy to navigate.”

“Presentation and explanation cultural content many non Aboriginal clinical staff do not consider.”

Feedback from our participants on the ‘best aspects’ from the first module

“Loved the way it was laid out, very easy to understand, excellent information.”

“Interactive and well presenting. The information presented is relevant and succinct.”

“Statistics and explanation around cultural barriers for those that don’t work in this environment.”

“Format was easy to follow and engaging. Cultural learning was applicable to all areas of health not just respiratory health.”

“Flowed well, easy to navigate.”

“Presentation and explanation cultural content many non Aboriginal clinical staff do not consider.”

90

This Module Will Take Approximately 90 Minutes to Complete

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