Asthma physical examination: Difference between revisions
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__NOTOC__ | |||
{{Asthma}} | {{Asthma}} | ||
{{CMG}}; {{ | {{CMG}}; {{AE}} {{LG}} | ||
==Overview== | ==Overview== | ||
The characteristic physical signs of asthma include loud | The characteristic physical signs of asthma include: loud prolonged [[wheeze|polyphonic expiratory wheeze]] and adventitious sounds such as [[rhonchi]]. Presence of wheeze is indicative of airway narrowing; however, the absence of wheeze indicates a silent lung characteristic of status asthmaticus delineated by widespread obstruction that results in significant airflow reduction and insufficient enough to produce a wheeze.<ref name="pmid28455155">{{cite journal| author=Korematsu S, Nagashima K, Sato Y, Nagao M, Hasegawa S, Nakamura H et al.| title="Spike" in acute asthma exacerbations during enterovirus D68 epidemic in Japan: A nation-wide survey. | journal=Allergol Int | year= 2017 | volume= | issue= | pages= | pmid=28455155 | doi=10.1016/j.alit.2017.04.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28455155 }} </ref> | ||
== | ==Physical Examination== | ||
Physical examination may be normal or characteristically present with a loud polyphonic expiratory wheeze. Nasal examination is mandatory to rule out associated conditions such as aspirin sensitivity or allergic rhinitis. | Physical examination may be normal or can be characteristically present with a loud polyphonic expiratory [[wheeze]].<ref name="pmid28455155">{{cite journal| author=Korematsu S, Nagashima K, Sato Y, Nagao M, Hasegawa S, Nakamura H et al.| title="Spike" in acute asthma exacerbations during enterovirus D68 epidemic in Japan: A nation-wide survey. | journal=Allergol Int | year= 2017 | volume= | issue= | pages= | pmid=28455155 | doi=10.1016/j.alit.2017.04.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28455155 }} </ref><ref name="pmid28449460">{{cite journal| author=Tan JHY, Chew WM, Lapperre TS, Tan GL, Loo CM, Koh MS| title=Role of bronchoprovocation tests in identifying exercise-induced bronchoconstriction in a non-athletic population: a pilot study. | journal=J Thorac Dis | year= 2017 | volume= 9 | issue= 3 | pages= 537-542 | pmid=28449460 | doi=10.21037/jtd.2017.02.70 | pmc=5394074 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28449460 }} </ref> | ||
===Vitals=== | |||
====Pulse==== | |||
=====Rate===== | |||
*Increased [[heart rate]] in acute severe episode | |||
=====Strength===== | |||
*[[Pulsus paradoxus]] (a fall of SBP between 10-20mmHg during inspiration) in moderately severe episode | |||
*[[Pulsus paradoxus]] (a fall of SBP greater than 20-40 mmHg during inspiration) in acute severe episode and imminent respiratory failure | |||
====Respiratory Rate==== | |||
*Increased [[respiratory rate]] greater than 30 cycles per minute in moderately severe and acute severe episodes | |||
===Skin=== | |||
*Profuse [[sweating]] in imminent respiratory failure | |||
*Severe hypoxia resulting in [[central cyanosis]] and hypoventilation in imminent respiratory failure | |||
===Eyes=== | |||
*Conjunctival congestion as a consequence of constant rubbing are suggestive of associated [[allergic rhinitis]]. | |||
===Nose=== | |||
*Nasal examination is mandatory to rule out associated conditions such as, aspirin sensitivity or allergic rhinitis. | |||
*Transverse crease on nose as a consequence of constant rubbing and pale swollen nasal mucosa are suggestive of associated [[allergic rhinitis]]. | |||
===Lungs=== | |||
====Mild Episode==== | ====Mild Episode==== | ||
*Prolong end-expiratory [[wheeze]] | *Prolong end-expiratory [[wheeze]] | ||
*In between attacks, chest is clear and no abnormal physical signs may be detectable. | *In between attacks, chest is clear and no abnormal physical signs may be detectable. | ||
====Moderately Severe Episode==== | ====Moderately Severe Episode==== | ||
*Use of accessory muscles of respiration such as sternocleidomastoid and scalene muscles | *Use of accessory muscles of respiration such as sternocleidomastoid and scalene muscles | ||
*Hyper-resonant lungs | *Hyper-resonant lungs | ||
*Loud | *Loud prolonged expiratory wheeze with a reduced inspiration to expiration ratio | ||
*Vesicular breath sounds with | *Vesicular breath sounds with prolonged respiration | ||
====Acute Severe Episode==== | ====Acute Severe Episode==== | ||
* | *Patient has to sit upright with arms extended to support the upper chest (tripod position) that assist the use of accessory muscles of respiration | ||
*Use of accessory muscles of respiration | *Use of accessory muscles of respiration | ||
====Imminent Respiratory Failure==== | ====Imminent Respiratory Failure==== | ||
*Paradoxical thoraco-abdominal breathing | *Paradoxical thoraco-abdominal breathing | ||
*[[ | *[[Wheeze]] and breath sounds are typically absent secondary to severe airway obstruction, representing a ''silent chest'' which is an ominous sign. | ||
====Chronic Asthma==== | ====Chronic Asthma==== | ||
*Persistent scattered [[rhonchi]] | *Persistent scattered [[rhonchi]] | ||
=== | ===Other Associated Findings=== | ||
*Triad of [[asthma]], [[nasal polyps]] and [[rash]] is indicative of [[Aspirin desensitization|aspirin sensitivity]]. | *Triad of [[asthma]], [[nasal polyps]] and [[rash]] is indicative of [[Aspirin desensitization|aspirin sensitivity]]. | ||
*Presence of [[clubbing]] in asthma may be secondary to [[interstitial lung disease]]. | *Presence of [[clubbing]] in asthma may be secondary to [[interstitial lung disease]]. | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Immunology]] | |||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category: | [[Category:Mature chapter]] | ||
Latest revision as of 20:30, 29 July 2020
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Asthma Microchapters |
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Asthma physical examination On the Web |
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American Roentgen Ray Society Images of Asthma physical examination |
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Risk calculators and risk factors for Asthma physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
The characteristic physical signs of asthma include: loud prolonged polyphonic expiratory wheeze and adventitious sounds such as rhonchi. Presence of wheeze is indicative of airway narrowing; however, the absence of wheeze indicates a silent lung characteristic of status asthmaticus delineated by widespread obstruction that results in significant airflow reduction and insufficient enough to produce a wheeze.[1]
Physical Examination
Physical examination may be normal or can be characteristically present with a loud polyphonic expiratory wheeze.[1][2]
Vitals
Pulse
Rate
- Increased heart rate in acute severe episode
Strength
- Pulsus paradoxus (a fall of SBP between 10-20mmHg during inspiration) in moderately severe episode
- Pulsus paradoxus (a fall of SBP greater than 20-40 mmHg during inspiration) in acute severe episode and imminent respiratory failure
Respiratory Rate
- Increased respiratory rate greater than 30 cycles per minute in moderately severe and acute severe episodes
Skin
- Profuse sweating in imminent respiratory failure
- Severe hypoxia resulting in central cyanosis and hypoventilation in imminent respiratory failure
Eyes
- Conjunctival congestion as a consequence of constant rubbing are suggestive of associated allergic rhinitis.
Nose
- Nasal examination is mandatory to rule out associated conditions such as, aspirin sensitivity or allergic rhinitis.
- Transverse crease on nose as a consequence of constant rubbing and pale swollen nasal mucosa are suggestive of associated allergic rhinitis.
Lungs
Mild Episode
- Prolong end-expiratory wheeze
- In between attacks, chest is clear and no abnormal physical signs may be detectable.
Moderately Severe Episode
- Use of accessory muscles of respiration such as sternocleidomastoid and scalene muscles
- Hyper-resonant lungs
- Loud prolonged expiratory wheeze with a reduced inspiration to expiration ratio
- Vesicular breath sounds with prolonged respiration
Acute Severe Episode
- Patient has to sit upright with arms extended to support the upper chest (tripod position) that assist the use of accessory muscles of respiration
- Use of accessory muscles of respiration
Imminent Respiratory Failure
- Paradoxical thoraco-abdominal breathing
- Wheeze and breath sounds are typically absent secondary to severe airway obstruction, representing a silent chest which is an ominous sign.
Chronic Asthma
- Persistent scattered rhonchi
Other Associated Findings
- Triad of asthma, nasal polyps and rash is indicative of aspirin sensitivity.
- Presence of clubbing in asthma may be secondary to interstitial lung disease.
References
- ↑ 1.0 1.1 Korematsu S, Nagashima K, Sato Y, Nagao M, Hasegawa S, Nakamura H; et al. (2017). ""Spike" in acute asthma exacerbations during enterovirus D68 epidemic in Japan: A nation-wide survey". Allergol Int. doi:10.1016/j.alit.2017.04.003. PMID 28455155.
- ↑ Tan JHY, Chew WM, Lapperre TS, Tan GL, Loo CM, Koh MS (2017). "Role of bronchoprovocation tests in identifying exercise-induced bronchoconstriction in a non-athletic population: a pilot study". J Thorac Dis. 9 (3): 537–542. doi:10.21037/jtd.2017.02.70. PMC 5394074. PMID 28449460.