Asthma history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The clinical presentation of asthma varies with individuals both | The clinical presentation of asthma varies with individuals both, with and without clinical therapies; meaning asthma can manifest as environmental stimulated or therapy-resistant. In some, asthma is characterized by '''chronic respiratory impairment''' while others experience '''episodic attacks''' secondary to a number of triggering events including: [[upper respiratory tract infection]], [[stress]], cold air, [[Exercise induced asthma|exercise]], exposure to [[allergen]] (such as pets, dust, mites, pollen) or air pollutants (such as smoke or traffic fumes). The '''cardinal symptoms''' of asthma include [[wheeze|loud expiratory wheeze]], [[cough|nocturnal cough]] and [[dyspnea]]. Other non-specific symptoms such as severe [[shortness of breath]], chest tightness, [[stridor]] in the absence of a [[wheeze]] may be confused with a [[COPD|COPD-type]] of disease and hence it is difficult to diagnose asthma based upon the history alone.<ref name="pmid6861547">Pratter MR, Hingston DM, Irwin RS (1983) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6861547 Diagnosis of bronchial asthma by clinical evaluation. An unreliable method.] ''Chest'' 84 (1):42-7. PMID: [http://pubmed.gov/6861547 6861547]</ref><ref name="pmid2178528">Irwin RS, Curley FJ, French CL (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2178528 Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy.] ''Am Rev Respir Dis'' 141 (3):640-7. PMID: [http://pubmed.gov/2178528 2178528]</ref><ref name="pmid2802893">Pratter MR, Curley FJ, Dubois J, Irwin RS (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2802893 Cause and evaluation of chronic dyspnea in a pulmonary disease clinic.] ''Arch Intern Med'' 149 (10):2277-82. PMID: [http://pubmed.gov/2802893 2802893]</ref> The majority of patients who develop asthma prior to adolescence may experience subsequent remission around puberty. These same asthmatics, however, have the potential for increased frequency of recurrences several years after puberty.<ref name="pmid1416415">Yunginger JW, Reed CE, O'Connell EJ, Melton LJ, O'Fallon WM, Silverstein MD (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1416415 A community-based study of the epidemiology of asthma. Incidence rates, 1964-1983.] ''Am Rev Respir Dis'' 146 (4):888-94. PMID: [http://pubmed.gov/1416415 1416415]</ref> Thereby, the '''National Asthma Education and Prevention Program''' emphasized the importance of assessment of frequency, severity, duration, limitations of daily activities and future risk of exacerbations to monitor the patient's level of asthma control.<ref name="pmid17983880">National Asthma Education and Prevention Program (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17983880 Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007.] ''J Allergy Clin Immunol'' 120 (5 Suppl):S94-138. [http://dx.doi.org/10.1016/j.jaci.2007.09.043 DOI:10.1016/j.jaci.2007.09.043] PMID: [http://pubmed.gov/17983880 17983880]</ref> | ||
==History and Symptoms== | ==History and Symptoms== | ||
====Episodic asthma (Asthmatic attack)==== | ====Episodic asthma (Asthmatic attack)==== | ||
[[Allergens]], [[Exercise induced asthma|exercise]] or viral infections<ref name="pmid10470697">Stein RT, Sherrill D, Morgan WJ, Holberg CJ, Halonen M, Taussig LM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10470697 Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years.] ''Lancet'' 354 (9178):541-5. [http://dx.doi.org/10.1016/S0140-6736(98)10321-5 DOI:10.1016/S0140-6736(98)10321-5] PMID: [http://pubmed.gov/10470697 10470697]</ref> may trigger an acute exacerbation of asthma | [[Allergens]], [[Exercise induced asthma|exercise]] or viral infections<ref name="pmid10470697">Stein RT, Sherrill D, Morgan WJ, Holberg CJ, Halonen M, Taussig LM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10470697 Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years.] ''Lancet'' 354 (9178):541-5. [http://dx.doi.org/10.1016/S0140-6736(98)10321-5 DOI:10.1016/S0140-6736(98)10321-5] PMID: [http://pubmed.gov/10470697 10470697]</ref> may trigger an acute exacerbation of asthma. An acute exacerbation of asthma can be characterized by: | ||
* Sudden onset of [[wheeze]] (primarily upon expiration, but can be in both [[Respiration (physiology)|respiratory phases]]) | |||
* [[Dyspnea]] and/or [[cough]] with clear [[sputum]] that lasts for hours, days or weeks | |||
* Patients with episodic asthma have paroxysms of symptoms with intervening asymptomatic episodes. | |||
====Severe acute asthma ([[Status asthmaticus]])==== | ====Severe acute asthma ([[Status asthmaticus]])==== | ||
Severe acute asthma is a '''life-threatening condition''', characterized by severe airway obstruction and persistence of symptoms despite initial administration of [[bronchodilators]] and [[corticosteroids]]. Symptoms include [[dyspnea| | Severe acute asthma is a '''life-threatening condition''', characterized by severe airway obstruction and persistence of symptoms despite initial administration of [[bronchodilators]] and [[corticosteroids]]. Symptoms include: | ||
* [[dyspnea|Rapidly progressive dyspnea]] | |||
* [[cough|Non-productive cough]] | |||
* [[sweating|Profuse sweating]] | |||
* [Cyanosis]] | |||
* And/or [[loss of consciousness]] secondary to [[hypoxia|severe hypoxia]]. | |||
Patients adopt a '''tripod position''' to assist the use of accessory muscles of respiration (such as the sternocleidomastoid and scalene muscles). | |||
At this stage, the airway obstruction is significantly reduced and results in severe impairment of air motion that leads to a '''silent chest''' with the [[wheeze|absence of wheeze]] suggestive of an imminent [[Respiratory failure|respiratory arrest]] and death. | At this stage, the airway obstruction is significantly reduced and results in severe impairment of air motion that leads to a '''silent chest''' with the [[wheeze|absence of wheeze]] suggestive of an imminent [[Respiratory failure|respiratory arrest]] and death. | ||
====Chronic asthma==== | ====Chronic asthma==== | ||
Chronic symptoms include [[wheeze| | Chronic symptoms include: | ||
* [[wheeze|Episodic wheeze]] | |||
* [[dyspnea|Exertional dyspnea]] | |||
* [[cough|Chronic cough]] associated with [[sputum|mucoid sputum]] secondary to '''non-compliance''' to [[asthma medical therapy|medical therapy]]. | |||
* Nocturnal [[cough]] or [[wheeze]] with typical early morning awakening may be present. However, patients with chronic asthma are more predisposed to frequent '''recurrent exacerbations'''. | |||
==Relevant History== | ==Relevant History== | ||
*In a vast majority of cases, it is often difficult to diagnose asthma entirely on the basis of history and clinical examination findings. Thereby, a strong clinical suspicion is required if: | *In a vast majority of cases, it is often difficult to diagnose asthma entirely on the basis of history and clinical examination findings. Thereby, a strong clinical suspicion is required if: | ||
:* | :*A patient has a '''personal or family history''' suggestive of underlying allergic disorders such as [[allergic rhinitis]] or [[eczema]].<ref name="pmid10430729">Halonen M, Stern DA, Lohman C, Wright AL, Brown MA, Martinez FD (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10430729 Two subphenotypes of childhood asthma that differ in maternal and paternal influences on asthma risk.] ''Am J Respir Crit Care Med'' 160 (2):564-70. PMID: [http://pubmed.gov/10430729 10430729]</ref> | ||
:* | :*There is history of '''childhood asthma''' | ||
*Documentation of '''social and occupational history''' may reveal the possible [[Asthma risk factors|triggering factors]] and factors that contribute to non-adherence of therapy.<ref name="pmid10586889">Cookson W (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10586889 The alliance of genes and environment in asthma and allergy.] ''Nature'' 402 (6760 Suppl):B5-11. PMID: [http://pubmed.gov/10586889 10586889]</ref><ref name="pmid9164332">Venables KM, Chan-Yeung M (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9164332 Occupational asthma.] ''Lancet'' 349 (9063):1465-9. [http://dx.doi.org/10.1016/S0140-6736(96)07219-4 DOI:10.1016/S0140-6736(96)07219-4] PMID: [http://pubmed.gov/9164332 9164332]</ref> | *Documentation of '''social and occupational history''' may reveal the possible [[Asthma risk factors|triggering factors]] and factors that contribute to non-adherence of therapy.<ref name="pmid10586889">Cookson W (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10586889 The alliance of genes and environment in asthma and allergy.] ''Nature'' 402 (6760 Suppl):B5-11. PMID: [http://pubmed.gov/10586889 10586889]</ref><ref name="pmid9164332">Venables KM, Chan-Yeung M (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9164332 Occupational asthma.] ''Lancet'' 349 (9063):1465-9. [http://dx.doi.org/10.1016/S0140-6736(96)07219-4 DOI:10.1016/S0140-6736(96)07219-4] PMID: [http://pubmed.gov/9164332 9164332]</ref> | ||
Revision as of 15:47, 7 October 2011
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [3]
Overview
The clinical presentation of asthma varies with individuals both, with and without clinical therapies; meaning asthma can manifest as environmental stimulated or therapy-resistant. In some, asthma is characterized by chronic respiratory impairment while others experience episodic attacks secondary to a number of triggering events including: upper respiratory tract infection, stress, cold air, exercise, exposure to allergen (such as pets, dust, mites, pollen) or air pollutants (such as smoke or traffic fumes). The cardinal symptoms of asthma include loud expiratory wheeze, nocturnal cough and dyspnea. Other non-specific symptoms such as severe shortness of breath, chest tightness, stridor in the absence of a wheeze may be confused with a COPD-type of disease and hence it is difficult to diagnose asthma based upon the history alone.[1][2][3] The majority of patients who develop asthma prior to adolescence may experience subsequent remission around puberty. These same asthmatics, however, have the potential for increased frequency of recurrences several years after puberty.[4] Thereby, the National Asthma Education and Prevention Program emphasized the importance of assessment of frequency, severity, duration, limitations of daily activities and future risk of exacerbations to monitor the patient's level of asthma control.[5]
History and Symptoms
Episodic asthma (Asthmatic attack)
Allergens, exercise or viral infections[6] may trigger an acute exacerbation of asthma. An acute exacerbation of asthma can be characterized by:
- Sudden onset of wheeze (primarily upon expiration, but can be in both respiratory phases)
- Dyspnea and/or cough with clear sputum that lasts for hours, days or weeks
- Patients with episodic asthma have paroxysms of symptoms with intervening asymptomatic episodes.
Severe acute asthma (Status asthmaticus)
Severe acute asthma is a life-threatening condition, characterized by severe airway obstruction and persistence of symptoms despite initial administration of bronchodilators and corticosteroids. Symptoms include:
- Rapidly progressive dyspnea
- Non-productive cough
- Profuse sweating
- [Cyanosis]]
- And/or loss of consciousness secondary to severe hypoxia.
Patients adopt a tripod position to assist the use of accessory muscles of respiration (such as the sternocleidomastoid and scalene muscles).
At this stage, the airway obstruction is significantly reduced and results in severe impairment of air motion that leads to a silent chest with the absence of wheeze suggestive of an imminent respiratory arrest and death.
Chronic asthma
Chronic symptoms include:
- Episodic wheeze
- Exertional dyspnea
- Chronic cough associated with mucoid sputum secondary to non-compliance to medical therapy.
- Nocturnal cough or wheeze with typical early morning awakening may be present. However, patients with chronic asthma are more predisposed to frequent recurrent exacerbations.
Relevant History
- In a vast majority of cases, it is often difficult to diagnose asthma entirely on the basis of history and clinical examination findings. Thereby, a strong clinical suspicion is required if:
- A patient has a personal or family history suggestive of underlying allergic disorders such as allergic rhinitis or eczema.[7]
- There is history of childhood asthma
- Documentation of social and occupational history may reveal the possible triggering factors and factors that contribute to non-adherence of therapy.[8][9]
References
- ↑ Pratter MR, Hingston DM, Irwin RS (1983) Diagnosis of bronchial asthma by clinical evaluation. An unreliable method. Chest 84 (1):42-7. PMID: 6861547
- ↑ Irwin RS, Curley FJ, French CL (1990) Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis 141 (3):640-7. PMID: 2178528
- ↑ Pratter MR, Curley FJ, Dubois J, Irwin RS (1989) Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med 149 (10):2277-82. PMID: 2802893
- ↑ Yunginger JW, Reed CE, O'Connell EJ, Melton LJ, O'Fallon WM, Silverstein MD (1992) A community-based study of the epidemiology of asthma. Incidence rates, 1964-1983. Am Rev Respir Dis 146 (4):888-94. PMID: 1416415
- ↑ National Asthma Education and Prevention Program (2007) Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol 120 (5 Suppl):S94-138. DOI:10.1016/j.jaci.2007.09.043 PMID: 17983880
- ↑ Stein RT, Sherrill D, Morgan WJ, Holberg CJ, Halonen M, Taussig LM et al. (1999) Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 354 (9178):541-5. DOI:10.1016/S0140-6736(98)10321-5 PMID: 10470697
- ↑ Halonen M, Stern DA, Lohman C, Wright AL, Brown MA, Martinez FD (1999) Two subphenotypes of childhood asthma that differ in maternal and paternal influences on asthma risk. Am J Respir Crit Care Med 160 (2):564-70. PMID: 10430729
- ↑ Cookson W (1999) The alliance of genes and environment in asthma and allergy. Nature 402 (6760 Suppl):B5-11. PMID: 10586889
- ↑ Venables KM, Chan-Yeung M (1997) Occupational asthma. Lancet 349 (9063):1465-9. DOI:10.1016/S0140-6736(96)07219-4 PMID: 9164332