Asthma history and symptoms

Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Philip Marcus, M.D., M.P.H. [mailto:pmarcus192@aol.com];

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. 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. 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.

Episodic asthma (Asthmatic attack)
Allergens, exercise or viral infections 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: Patients adopt a tripod position to assist the use of accessory muscles of respiration (such as the sternocleidomastoid and scalene muscles).
 * Rapidly progressive dyspnea
 * Non-productive cough
 * Profuse sweating
 * [Cyanosis]]
 * And/or loss of consciousness secondary to severe hypoxia.

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.


 * 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.