• Welcome to The Fishbowl! This site has been created by doctors for doctors! It's purpose is to provide a medium for discussion among Australian and New Zealand based doctors. There is a vast amount of knowledge between us, though somewhat limited, inconvenient and fragmented avenues to share this. We encourage discussion about anything and everything from clinical cases, questions, advice, opinions and whatever else you might think of. It is our eventual hope that we get enough members to really open up the communication channels between all specialties. We're a private community that requires a membership to view the forums. Your name and AHPRA or MCNZ registration number is required to register - these will not be visible on your profile or shared. This site only went live early June 2019 and we are continuing to grow slowly - if you are new feel free to introduce yourself in the Introduction thread! (Apologies for the text wall - I can't seem to format this section the way I'd like) - Kris
  • The following lists aren't exhaustive - If you find anything new please add it in the relevant thread and we can update the lists.

Resources Respiratory

Admin

Administrator
Staff member
Topics:

Core Topics (from BEACH data):
- Cough
- Sleep disturbance
- Asthma
- Bronchitis
- URTI

Cough, Wheeze, SOB
Asthma
Spirometry
COPD
Interstitial lung disease
Pneumonia
Tuberculosis
Pertussis
Lung cancer
Pulmonary embolism
Obstructive sleep apnoea

Resources:

gplearning Respiratory - AJGP and Check:
- AFP Clinical Challenge, August 2015: Thorax
- check, unit 528, Respiratory disease, June 2016
- Identifying and managing risk factors for thunderstorm asthma
- AFP Clinical Challenge, June 2015: Common dilemmas in kids (Sleep apnoea in the child, the wheezing child)
- AFP Clinical Challenge, November 2017: Chest pain revisited

AFP 2012 - Tuberculosis testing
AFP Aug 2015 - Interstitial lung disease: where are we now?
AFP Aug 2015 - Adult onset asthma
AFP Aug 2015 - Guide to thoracic imaging
AFP 2015 - Sleep apnoea in the child
AFP 2011 - Spirometry
AFP Nov 2017 - Pulmonary embolism: an update

Asthma handbook - Adults
Asthma handbook - Adolescents
Asthma handbook - Children

Investigating symptoms of lung cancer (cancer Australia resource): A guide for GPs

Lung Foundation - COPD Guidelines
Lung Foundation - COPD: Stepwise management Feb 2019
Lung Foundation - COPD Action Plan - This link includes indigenous COPD Action Plan

Respiratory Medicine Today April 2019 - Stepping patients through COPD management
Respiratory Medicine Today Oct 2018 - Inhaled corticosteroids: when are they needed, not needed, and when harmful?
Respiratory Medicine Today Oct 2018 - Complexities in managing obesity in COPD
Respiratory Medicine Today June 2018 - Case review: Not another exacerbation of COPD
Respiratory Medicine Today October 2018 - Feature article: Reducing the burden of severe asthma
Respiratory Medicine Today June 2018 - Feature article: Managing asthma in pregnancy
Respiratory Medicine Today March 2019 - Bronchiectasis: a new dawn in diagnosis and treatment
Medicine Today July 2018 - Triple therapy in COPD: who needs it?
Medicine Today Dec 2016 - Asthma, COPD and when they co-exist

Ausdoc - The wheezing child
Ausdoc - Imaging and lung disease in adults
Ausdoc - Lung disease and investigations in adults
Ausdoc - Idiopathic pulmonary fibrosis
Ausdoc - How to treat suspected COPD in asymptomatic patients
 

Kris

Well-known member
Question:

15

For the diagnosis of asthma - does both of the above need to be present? ie FEV1 increase > 200ml and > 12% from baseline

AND

FEV1/FVC < Lower limit of normal for age (LLN)

If so, what is the diagnosis if there is documented reversibility on spirometry but FEV1/FVC is above LLN?
 

Jon

Member
Staff member
Question:

View attachment 15

For the diagnosis of asthma - does both of the above need to be present? ie FEV1 increase > 200ml and > 12% from baseline

AND

FEV1/FVC < Lower limit of normal for age (LLN)

If so, what is the diagnosis if there is documented reversibility on spirometry but FEV1/FVC is above LLN?
Hi Kris,

While it is important to have objective findings in asthma management, at the end of the day, the diagnosis is going to be a clinical one. Due to the absence of gold-standard diagnostic criteria, one must weigh up the various aspects of the clinical presentation and see if it justifies the asthma diagnosis.

There are several components to what may lead to the diagnosis. A large one being history/presentation. Symptoms of wheeze, breathlessness, cough and chest tightness, with airflow variability, diurnal variation, and hyper-responsiveness, are important factors. As are other bits of history such as atopy and family history.

I was always taught that one required objective criteria (i.e. spirometry) for the diagnosis to be made, as I went through training. However, several guidelines (such as the one from BTS) do subscribe to the fact that a clinical diagnosis is what is most important. In more recent times, looking into the validity of testing, it is estimated that spirometry can have a false negative rate of 50% or more in some references! Just because a patient tests a certain result on one day, doesn't mean they will do so recurrently. Hence, serial assessments are key, with a demonstration of your reversibility criteria above; being supportive but not conclusively proving the diagnosis. If not suggestive on the initial screen, but suspected - refer for consideration of provocation tests. Other adjuncts, such as FeNO may be useful in demonstrating eosinophilic inflammation, but remember that a negative result does not exclude asthma either.

So if you see someone meeting some criteria, but not all of them - then I'd say that it would be a clinical judgement call, as to whether you think asthma the more likely diagnosis, or if another explanation may be present.

So in this case, not meeting the one LLN guideline, but ticking everything else and not making the diagnosis of asthma on one criterion, would otherwise be a bit odd to me.

Hope this helps!
 
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