Clinical Features

The symptoms of asthma consist of a triad of dyspnea, wheezing, and cough. Many patients will relay the history of asthma upon presentation, but some will not. Early in the attack, patients will complain of a sensation of chest constriction and cough. As the exacerbation progresses, wheezing becomes apparent, expiration becomes prolonged, and accessory muscle use may become evident. Key historical points should be obtained on asthmatics presenting with exacerbation to emergency departments (EDs) (T,a..ble...6.1-2.). Acute asthma exacerbation can be categorized based on clinical features (Table. . , 64-3).

TABLE 64-2 Key Historical Elements When Obtaining a History from Patients with Acute Asthma Exacerbation

Physical examination findings are variable. Patients presenting with a severe asthma attack may be in obvious respiratory distress, with rapid breathing and loud wheezing, whereas patients with mild exacerbation may present with cough and end-expiratory wheezing. At times, wheezing may be audible without a stethoscope. Other conditions may present with wheezing and mimic asthma (Table... . 64-4). The use of accessory muscles of inspiration indicates diaphragmatic fatigue, while the appearance of paradoxical respirations reflects impending ventilatory failure. Alteration in the mental status—e.g., lethargy, exhaustion, agitation, or confusion—also heralds respiratory arrest.

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