Learning Center Articles

Clinical manifestation : Asthma

Clinical manifestation

Recurrent episodes of wheezing, breathlessness, cough, and tight chest
Expiration may be prolonged.
- Inspiration-expiration ratio of 1:2 to 1:3 or 1:4
- Bronchospasm, edema, and mucus in bronchioles narrow the airways
- Air takes longer to move out
Most common manifestations
- Cough
- Shortness of breath (dyspnea)
- Wheezing
- Chest tightness
- Variable airflow obstruction

Complications and classification

Mild
- Dyspnea occurs with activity and patient may feel that he or she “can’t get enough air.”
- PEF ≥70%
- Usually treated at home
  - Prompt relief with inhaled SABA such as albuterol (delivered via a nebulizer or MDI with a spacer)
  - Patients instructed to take 2 to 4 puffs albuterol every 20 min three times to gain rapid control of symptoms
  - Occasionally short course of oral corticosteroids is needed.
Moderate
- Dyspnea interferes with or limits usual activities.
- PEF 40%69%
  - Usually requires office or ED visit
  - Relief is provided with frequent inhaled SABA.
  - Oral systemic corticosteroids. (Symptoms may persist for several days even after corticosteroids are started.)
Severe exacerbations
- Respiratory rate >30/min
- Dyspnea at rest, feeling of suffocation
- Pulse >120/min
- PEFR is 40% at best
- Usually seen in ED or hospitalized
  - Partial relief from frequent inhaled SABA
  - Oral systemic corticosteroids. Some symptoms last for >3 days after treatment is begun.
  - Adjunctive therapy: ipratropium, IV magnesium
Life-threatening asthma
- Too dyspneic to speak
- Perspiring profusely
- Drowsy/confused
- PEFR <25%
- Require hospital care and often admitted to ICU
  - Minimal or no relief from frequent inhaled SABA
  - IV corticosteroids
  - Adjunctive therapy: ipratropium, IV magnesium