In any recurrent bronchitis more than once after age

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In any recurrent bronchitis (more than once) after age 13, underlying asthma should be ruled out. ] (2) Individuals MEET the standard if within the past 3 years they meet ALL of the criteria in subparagraphs 11.d.(2)(a)-(d). [ Could an applicant be disqualified for asthma symptoms one or two years ago, simply wait until he meets the 3 years and then be qualified? It looks that way ] (a) No use of controller or rescue medications (including, but not limited to inhaled corticosteroids, leukotriene receptor antagonists, or short-acting beta agonists). (b) No exacerbations requiring acute medical treatment. (c) No use of oral steroids. (d) A current normal spirometry (within the past 90 days), performed in accordance with American Thoracic Society (ATS) guidelines and as defined by current National Heart, Lung, and Blood Institute (NHLBI) standards. [ Order all spirometry (PFT) done with bronchodilators. If
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possible, order Exercise PFT (EPFT) with EIA, never order MCT for EIA. MCT can only be used to evaluate allergy-based asthma. If you are not sure, order a pulmonology consult for help after consulting with your Branch Surgeon-see more explanation below ] In a PFT, the most useful number in assessing the risk of future asthma attacks is the “ratio.” This is FEV 1 /FVC, and tells you if there is restrictive (fibrosis), or obstructive (asthma) airway disease present. Using a ratio of 0.80 (80%), it it goes up, there is restriction, if it goes down, there is obstruction present. A ratio below 0.80 is beginning to show obstruction, and a ratio down to 0.70 or lower is definite obstruction with a high risk of future reactive airway exacerbations. Repeating the test after inhalation of a short-acting bronchodilator will further confirm the reversibility of this obstruction if the FEV 1 increases 12% or more from the baseline, or by an increase over 10% or more of the predicted FEV 1 , then you have reversible airway obstruction consistent with asthma. The MCT (Methacholine Challenge Test) is the gold standard for diagnosing bronchial airway hyper- responsiveness. The drug, methacholine is a strong bronchial irritant and will cause spasm in anyone in high enough doses. It is like breathing-in ammonia fumes. So it is given in small doses up to 4 mg/mL. If it causes bronchospasm at this level (increase of 20% of their baseline FEV 1 ), it is likely reactive airway disease. Higher doses up to 16mg/mL are used, but might give a false positive since doses this high can cause bronchospasm in normal people. Incidentally, cold air and exercise do the same thing, this is why MCT is never used in EIA, it could cause an exaggerated response and even be fatal.
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