Asthma is a disease of the airways characterized by inflammation, hyperresponsiveness, and bronchoconstriction. The diagnosis is primarily a clinical one, based on a focused history and physical examination, to differentiate from other entities such as heart failure, pneumonia, and pulmonary embolism.
Our recent issue Emergency Department Management of Acute Asthma Exacerbations reviews the latest evidence in diagnostic and treatment strategies, including other pharmacologic treatments and newer management strategies to avoid intubation.
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Here are a few key points:
- The differential diagnosis for dyspnea includes COPD, heart failure, pneumonia, pulmonary embolism, and pneumothorax. See Table 4 in the issue for a list of physical examination findings for each.
- The National Asthma Education and Prevention Program2 classifies asthma exacerbations thus:
- Mild: well-appearing, dyspnea with light activity, subtle wheezing; symptoms usually resolve with treatment at home.
- Moderate: dyspnea inhibits activity, wheezing on exhalation, increased accessory muscle use, increased respiratory rate, tachycardia.
- Severe: dyspnea at rest, inability to speak sentences, significant accessory muscle use, tachypnea, tachycardia, diaphoresis, agitation, and altered mental status. Wheezing may be loud. Absent wheezing indicates impending respiratory failure; intubation should not be delayed if it is deemed necessary.
Last Updated on January 25, 2023