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. Which of the following is the most likely diagnosis for this patient?
a. Mild asthma exacerbation
b. Moderate asthma exacerbation
c. Severe asthma exacerbation
d. Heart failure exacerbation
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Answer: B. 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.