Airway Components

Spirometry assessment – Spirometry should be assessed for all individuals with asthma. Airflow limitation is indicated when FEV₁/FVC ratio <70% and FEV₁ <80% predicted, or based on comparison to agreed standards. For more information see Basic Lung Function & Bronchial Challenge Tests. The National Asthma Council Australia website provide useful resources and tools on how to perform spirometry.

Spirometry assessment – Measurement of spirometry before and after administration of a rapid onset bronchodilator is considered reversible if FEV₁ increases by ≥200mL or ≥12%. Failure to demonstrate reversibility does not necessarily rule out a diagnosis of asthma, particularly in the severe asthma population. For more information see Diagnosis – Basic Lung Function

Modified Medical Research Council Scale (mMRC) – The mMRC scale is used to assess functional limitation due to dyspnoea (Mahler et al. 1988, Bestall et al. 1999). Participants grade their level of breathlessness symptoms using this 5-item scale. The scale ranges from 0-4, with 0 representing the least degree of functional limitation due to dyspnoea. A score equal to or greater than 2 indicates dyspnoea as a significant problem (Celli et al. 2005).

Dyspnoea Severity Index – Assesses upper airway symptoms and treatment follow-up. Consists of a 10-item 5-point Likert scale (Gartner-Schmidt et al. 2014).  Score > 10 suggestive of abnormal upper airway dyspnoea. Good reliability and discriminant validity reported, but has not been reported as a diagnostic tool and not specific for VCD. For access email: gartnerschmidtjl@upmc.edu

Dyspnoea-12 – The Dyspnoea-12 is a 12-item assessment tool that provides an overall score of dyspnoea magnitude (scored 0-36, higher score indicate more severe dyspnoea) as well as two sub-scores: i) physical component and ii) affective component. It has been validated in a range of conditions including asthma, it is simple and quick to use. It has a minimal clinically important difference of 3 points (calculated for COPD and lung cancer) (Yorke et al. 2010). More information is available here – http://thorax.bmj.com/content/65/1/21.

Download the Dyspnoea-12 questionnaire here.

Induced sputum cell counts – Characterisation of immune cell proportions in induced sputum samples can provide insights into the type of airway inflammation and possible underlying disease mechanisms. Inflammation may be defined as neutrophilic (≥61% neutrophils), eosinophilic (≥3% eosinophils), paucigranulocytic or mixed granulocytic inflammatory phenotypes based on microscopy assessment (Simpson et al. 2006).

For more information see Diagnosis – Sputum

Resources to guide assessment & quantification – A step-by-step guide for induced collection, processing and analysis is available on from the European Respiratory Society.

Antibiotic courses – Requirement for ≥2 antibiotic courses in 12-months for infective bronchitis.

Sputum culture – Presence of a recognised pathogen in sputum culture.

Allergic bronchopulmonary aspergillosis (ABPA) – ABPA is a hypersensitivity reaction to Aspergillus fungal species. Diagnosis requires chest X-ray or high-resolution CT, skin prick test to Aspergillus, Aspergillus detection in blood or sputum culture and assessment of IgE levels.

For ABPA diagnostic criteria click here

The lung normally produces approximately 20 – 30 mL of mucus per day. When an excess amount is produced and needs to be expectorated, it is termed sputum. Can be assessed based on the question of whether a patient has produced a volume ≥25mL of sputum production daily in the past week in the absence of an infection (Rabe et al. 2007).

The Bronchiectasis Toolbox provides additional information about mucus assessment based on volume and colour.

See Diagnosis & Assessment – Imaging (Computed tomography)

See Diagnosis & Assessment – Bronchoscopy

6-Minute Walk Test (6MWT) – The 6MWT is a sub-maximal exercise test used to measure exercise capacity.  Individuals are asked to walk as far and as fast as they can for a 6-minute period, by_.  A change in the distance walked in the 6MWT can be used to assess for treatment efficacy (Holland et al. 2014).

A protocol for conducting 6MWTs  can be found at: https://pulmonaryrehab.com.au/patient-assessment/assessing-exercise-capacity/six-minute-walk-test/