Asthma | Clinical Features and Diagnosis | Retired

[Music] all right so now let's move on to the signs and symptoms now here's the thing with asthma it's not always clear-cut you're not always going to have these perfect hallmark signs of asthma but for the most part okay you're they're going to present with cough and sometimes that cough can be productive whether you can look at the sputum under histology and you might see two important things that can come up but again you might be able to pick up a cough the next thing is when we look at this they usually also kind of present with a tightness in the chest because of having a difficulty breathing so they might also present with some chest tightness and again that difficulty breathing and we're going to put that as shortness of breath or sob we also call it dyspnea right so they might present with dyspnea shortness of breath chest tightness and a cough those are some of the things that you might be able to pick up on okay obviously having a little bit more information into their history is also very very critical in this but some of the things that you might be able to pick up on physical exam is if you're looking at them just upon inspection or listening to them they might not be able to completely finish all their sentences because they might be struggling to be able to breathe or catch their breath so that's one thing just upon initial kind of conversation is they might not be able to difficulty in finishing their speech difficulty speaking and this is not due to some type of neurological condition it's just they're having a hard time breathing that they can't get enough of those words out to complete a full sentence another thing is you want to look if they're really having a hard time breathing they might be utilizing accessory muscles so they might be utilizing their scalenes their sternocleidomastoid you might see some intercostal retraction maybe some excessive rising of the chest so look to see if there's any accessory muscle use okay let's say that you move on you go through your inspection you go through your palpation and you go to do percussion when you're percussing sometimes what you might be able to have is because in people who have asthma it's mainly considered as an obstructive lung disease obstructive lung disease mean that they trap a lot of air okay so they usually have hyperinflation of the lungs if you took a chest x-ray they might have hyperinflational lungs air trapping so because of that whenever you're percussing they might have a lot of higher pitched sound this is called hyper resonance so they might have hyper resonant so hyper resonance to percussion the next thing is let's say that you listen you do some auscultation and you hear some wheezing sounds okay those wheezings are particularly usually upon expiration so they kind of have a prolonged expiration and there's wheezing that might be heard so they might have wheezing upon expiration now here's the thing just because they have wheezing most people will say oh that's definitely asthma that's not always true you always want to go through your differential and think about things that could also wheeze copd they usually have some wheezing as well there's many different conditions that can present with wheezing just because they're wheezing doesn't mean that you can say oh that's asthma most people associate with that but that's not the only condition that can present with wheezing okay but again these are some of the big things that you'll pick up from the signs and the symptoms and also your physical examination but again big things that you want to remember they present sometimes with a cough they might have difficulty speaking and wheezing are some of the big ones okay but then again we said that you can go and you can look at the uh the sputum if they do have that productive cough we can actually take and look at some of the actual dispute and we can look at it under a microscope and it can show two different types of things one is it can show what's called cursement spirals so kirschmann spirals and all curcumin spirals are is in the bronchioles you can have this mucus and epithelial tissue that can get clogged in the bronchioles so imagine here i have like a little bronchial tube so here i'm going to have a bronchial tube okay and then what happens is i can have a lot of mucus build up in there and i might even have some epithelial cells so there might even be some epithelial tissue in there here we'll put that in black we'll put some dots in there so there's some epithelial tissue and there's some mucus whenever we try to cough that up it might come up as like a cast in other words it takes the shape of the actual bronchial okay so again because they take on that form or that shape you're going to see two big things one is you're going to see the epithelium and you're also going to see some mucous plugging okay so that's one big thing the other thing that you might see is what's called shark hot laden crystals okay so you might also see what's called shark hot leading crystals and all these are is again remember what type of white blood cell was commonly associated with asthma eosinophils right so sometimes you might have breakdown products holy crap let's switch this to this color we're going to go with this eosinophil right here so here we're going to have our eosinophil again we got that bilobe nucleus making little cool little like glasses there right and here we're going to have the eos and stained granules what happens is this actual eosinophil can get broken down and the broken down remaining pigments of the eosinophil can show up on histological preparation right and that's called charcot-laden crystals so it's just broke down pigments of eosinophils so again what you might be able to pick up from the actual sputum if they do have that productive cough okay this might be that sputum you can go ahead and do a histological preparation here and you might see kershamen spirals which are going to be epithelial mucus cass or charcot laden crystal which is just broke down pigments of eosinophils okay so that's the signs and symptoms now we move on from here we say okay i definitely think that based on their history based on their science and symptoms i go through my differential and i rule out every other kind of cause like you know i rule out wheezing i rule out bronchiolitis i rule out allergic bronchopulmonary aspergillus i rule out church straus syndrome i rule out all these different types of conditions and i come to the point oh this is definitely asthma now i'm going to go ahead and do my diagnostic protocol what is that going to start with generally what we can do is if they're if they're symptomatic let's say that they are symptomatic the first thing that we can do is we can do a pulmonary function test this is obviously the gold standard if we can but we're going to do what's called a pulmonary function test they also abbreviate these pfts okay we have videos on these we're not going to go into all the detail on these but again if you want to know a little bit more about them we have this in our engineered science playlist and the respiratory playlist okay but pulmonary function tests what we're going to have them do is we're going to have them take and take a breath in as much as they can and breathe out as much air as they possibly can and we're going to register that based upon a graphical process procedure what we get out of this the the most important points that we're going to get out of an actual pulmonary function test is we're going to get a reading on what's called the fvc which is called your forced vital capacity and the other one is going to be the forced expiratory volume at one second okay these are two really really important things that we're going to get from the pfts now someone who has asthma will have a low fvc but they'll have even a more significantly lower fev1 now let's imagine i get the numbers and i plug these and i try to figure out my ratio i do the fev1 over the fvc just look at this logically the fev1 is on the top it's our numerator the fvz is on the fvc is on the bottom if the numerator is much much much much more lower than the denominator what's our overall number going to be it's going to be low we use a standardized number now some books will say 80 some books will say 70 some will say 75 percent from what i learned based upon um my professor and the cmdt it gives us that it's mainly around 75 so usually if the fev won over the fvc ratio is less than 75 percent then we can go ahead and we can say oh this can help us to lead to this is definitely an obstructive condition that doesn't mean that we can just diagnose asthma it just lets us know oh there's definitely an obstructive pattern going on here so all this tells us is that there is some type of obstructive pattern what we'll do next is if they are symptomatic well this will be their initial pfts what we'll do is we'll follow up and we'll do a bronchodilator so then what we'll do is we'll take and we'll give them a bronchodilator usually what we'll give them is we'll give them what's called a saba so what that means is a saba is a short acting beta 2 here i'm going to put a little subscript 2 there beta a short acting beta 2 agonist what that means is it binds on to the beta-2 receptors and the respiratory bronchioles the smooth muscle and causes it to relax it dilates the bronchioles now if you give them the sabbah and you repeat the pfts so you do a repeat and you notice that the fev one significantly improved okay so it increased greater than or equal to 12 so if the fev1 is greater than or equal to 12 percent after saba that helps us to say that this is definitely asthma it is most likely asthma and that usually helps us to confirm that okay here's the reason why what was that big thing i told you about asthma it's reversible if you treat it it usually can go back to normal here's why this is important because if you did this and let's do this in a different color let's say that you do you get an fev1 and it increased but it was still less than or it was less than 12 percent so it was less than 12 percent after saba well we know that based upon their initial fev1 fec ratio it was an obstructive pattern but we found out that after giving them a sabbah they responded properly we said that's definitely asthma greater than 12 percent if it's less than 12 percent we know it's an obstructive condition but we know it's definitely not asthma anymore it's most likely copd okay and copd is usually your chronic bronchitis and your emphysema they usually often coexist okay so that's the first thing we do but here's the thing we really can only do this whenever the patient is symptomatic because if they're not symptomatic you're not going to be able to get the initial readings okay and then do the bronchodilator and then re-evaluate so sometimes what we have to do is we might have to do actually provoke the response so we might have to do another different test and this is called the methacholine challenge test so we might have to do instead is if the patient is asymptomatic we might have to do the methacholine challenge test what we do is we actually take the patient and we're gonna do the pfts okay we're gonna do the same thing so we're gonna do the pfts okay and it's gonna give us the same thing right it's going to give us the same thing that we already know that they'll have a significantly low fev1 we know that they'll have a low fvc and we know that they'll have an fev1 over fvc ratio that's less than 75 percent what we're going to do is we're going to give them an acetylcholine like uh agonist okay our muscarinic agonist and this is called methacholine it's basically like acetylcholine what it does is it binds onto the muscarinic receptors that are present within the respiratory passageways and it causes them to constrict so the response here is this going to cause broncho constriction now if a person has asthma their actual bronchi are going to spasm pretty significantly but if it's someone who has asthma we already know that they have a hyper reactive smooth muscle so it's going to contract pretty intensely so you'll repeat their pfts and what will you see their fev1 is going to drop 20 percent or more from the original fv1 that is no bueno we do not want that okay that's bad stuff there so that usually helps us to identify that this is most likely asthma so again if they're symptomatic we can do the pft saba and then reevaluate all right so if they're asymptomatic then we'll do the methacholine challenge test and we'll look to see for their pfts to drop specifically fe weave one drop 20 percent or more from the original other things that we can do they're not as specific but you can do them is you can also do a cbc if you did a cbc try to think about this at home what would you expect to see well you're checking your white blood cells right which one of the specific white blood cells would be elevated eosinophils right so we might see some elevation in the eosinophils so we would have to ask for a white blood cell differential and that would show us that we might have some elevated eosinophils we could also do a serology and we might see that there be elevated ige antibodies okay so these are some of the things that we could do and again i told you before that if you want to you could do a chest x-ray that the chest x-ray really is only just good at being able to rule out if they actually have pneumonia that's causing some of these exacerbating factors but really if it's just asthma it's just going to show hyperinflation okay so again not really necessary if they if you suspect that there might be pneumonia that's actually causing this exacerbating factors might be good to see if there's any low bar or broncho or interstitial pneumonia better than that not necessary this would be your gold standard is your pfts whether it be when they're symptomatic with the saba or asymptomatic with the methacholine all right ninja so in this video we talked about the signs of symptoms we talked about the diagnostic workup all the different tests the gold standards what you should see and and this is really important and i hope that it made sense i truly do hope you guys enjoyed it if you guys did please hit that like button comment down in the comment section and please subscribe in the next video we're going to go over the treatment protocol for those patients for long-term treatment for patients with asthma as well as we'll go through kind of an emergency emergency acute exacerbation of asthma and how we'd be able to identify that and treat that again if you guys could please go check out our facebook go check out our instagram even our patreon account we'll have that down in the description box also if you guys can go to our gofundme page donate any money there we would truly appreciate it helps us to purchase all the 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Channel: Ninja Nerd

Views: 187,168

Keywords: Ninja Nerd Lectures, Ninja Nerd, Ninja Nerd Science, education, whiteboard lectures, medicine, science, asthma attack, asthma, asthma symptoms, asthma treatment, asthma pathophysiology, asthma diagnosis, wheezing, Asthma lecture series, pulmonary function tests, spirometry, symptoms of asthma, asthma cough, peak flow, hallmark symptoms of asthma, diagnosis of asthma

Id: IyULJpBMS7w

Length: 16min 32sec (992 seconds)

Published: Tue Jan 05 2021