Test | Criteria of diagnostic finding | Practical method(s) |
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* The examination is particularly suitable for young persons in whom coronary heart disease is not suspected, and it should be used after consideration. In adult patients, exercise stress test or spiroergometry is usually performed when assessing respiratory or chest symptoms on exertion, whether the symptoms originate from the heart or lungs or the patient's working capacity. |
Spirometry | - Significant bronchodilatation response: 12% and 200 ml improvement in FEV1 or FVC
- FEV1 improves 15% and 200 ml during asthma treatment in long-term follow-up.
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PEF monitoring | - In 2-week PEF monitoring, 3 times a significant bronchodilatation response or 24-hour variation
- Significant bronchodilatation response: 15% and 60 l/min
- Significant 24-hour variation: 20% ja 60 l/min (see program Pef Calculator)
- Average PEF level increases 20% and 60 l/min during asthma treatment in long-term follow-up.
| - The patient measures the PEF value in the morning and later in the afternoon for 2 weeks. Three consecutive, forceful, brief blows are performed.
- All the three results are recorded; the best one is used for evaluation.
- The blows are repeated 15 minutes after the administration of a bronchodilating drug (salbutamol 400 µg or terbutaline 1 mg).
- Additionally, it is important to perform PEF measurement always when asthma symptoms appear (on exertion or allergen exposure, or in the night). The blows are performed in the same way as in the morning or evening.
- Provide the patient with adequate instructions and a tracking chart.
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Metacholine challenge test | - Moderate or strong bronchial hyperreactivity
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Exercise test* | - FEV1 or PEF decrease at least 15%.
| - After PEF or FEV1 recording the patient runs out of doors for 6 min, the lungs are auscultated and PEF or FEV1 value is recorded immediately after the exercise and repeatedly after 5, 10 and 15 min.
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Trial of glucocorticoid therapy | - Average PEF level increases 20% and 60 l/min during asthma treatment in long-term follow-up.
- FEV1 improves 15% and 200 ml during asthma treatment in long-term follow-up.
| - Oral prednisolone 20-40 mg/day is prescribed for 1 week in the exacerbation period of asthma. Alternatively, inhaled beclomethasone or budesonide 0.8 mg/day, fluticasone 0.5-1.0 mg/day or ciclesonide or mometasone in respective doses; in which case the follow-up time must be 8 weeks (see table of clinically comparable doses of inhaled glucocorticoids in Long-Term Management of Asthma).
- Spirometry is performed at the start and end of treatment. Morning and evening PEF values are monitored for one week at the beginning and another week at the end of the treatment period.
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