A 34-year-old woman presents to urgent care with dyspnea that is inhibiting her normal activities. She is talking in short sentences with mild accessory muscle usage. Her oxygen saturation is 92% to 94% on room air with diffuse wheezing, and she is tachypneic. Her peak expiratory flow rate is 60% of predicted, and her heart rate is 110 beats/minute.
Which of the following is the most likely diagnosis for this patient?
- Mild asthma exacerbation
- Moderate asthma exacerbation
- Severe asthma exacerbation
- Heart failure exacerbation
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Correct answer: b. Moderate asthma exacerbation
An adult patient with a moderate asthma exacerbation may complain of dyspnea that inhibits normal activity and may have notable shortness of breath while speaking, with increased accessory muscle usage. Vital signs in a moderate exacerbation typically include oxygen saturation of 90% to 95%, increased respiratory rate, and tachycardia. Peak expiratory flow rate would range from 40% to 69% of predicted; a rate <40% of predicted would indicate a severe exacerbation. Wheezing may be heard throughout exhalation on auscultation in a moderate exacerbation, while a severe exacerbation may present with decreased air entry or “silent chest.” In a mild exacerbation, vital signs are often normal except for mild tachypnea. A heart failure exacerbation would have findings such as rales, an S3 murmur, jugular venous distention, or peripheral edema, none of which are common in asthma exacerbations.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
