Symptoms & Clinical features in bronchial asthma
The symptoms of
asthma consist of a triad of dyspnea, cough and wheezing, the last often being
regarded as the sine qua non. In its most typical form, asthma is an episodic
disease, and all three symptoms coexist.
The lungs rapidly become over inflated and the anteroposterior diameter of the thorax increases. If the attack is severe or prolonged, there may be a loss of adventitial breath sounds, and wheezing becomes very high pitched.
Further, the accessory muscles become visibly active, and frequently, a paradoxical pulse will develop. These two signs have been found to be extremely valuable in indicating the severity of the obstruction.
In the presence of either, pulmonary function tends to be significantly more impaired than in its absence. It is important to note that the development of a paradoxical pulse will develop.
These two signs have been found to be extremely valuable in indicating the severity of the obstruction. In the presence of either pulmonary function tends to be significantly more impaired than in its absence.
It is important to note that the development of a paradoxical pulse and accessory muscle use depends on the generation of large negative intra-thoracic pressures. Thus, if the patients breathing is shallow.
These signs could be absent even though obstruction is quite severe. The other signs and symptoms of asthma imperfectly reflect the physiologic alterations that are present.
So much so that if one relies on the loss of subjective complaints, or even the sign of wheezing, as being the end point at which therapy for acute attack should be terminated, an enormous reservoir of residual disease is missed.
Termination of the episode is frequently marked by a cough producing thick, stringy mucus which often takes the form of casts of the distal airways and, when examined microscopically, often shows eosinophils and Charcot Leyden crystals.
In extreme situations, wheezing may markedly lessen or even disappear completely, cough may become extremely ineffective, and the patient may begin a gasping type of respiratory pattern.
These findings imply extensive mucous plugging and impending suffocation. Ventilatory assistance by mechanical means may be required.
Atelectasis due to inspissated secretions may occasionally occur with asthmatic attacks. Other complications such as spontaneous penumothorax and penumomediastinum are rare.
Less typically, a patient with asthma may complain of intermittent episodes of nonproductive cough or exertional dyspnea. Unlike other asthmatics when these patients are examined during their symptomatic periods.
They tend to have normal breath sounds but may wheeze after repeated forced exhalations and / or may show dynamic Ventilatory impairments when tested in the laboratory. In the absence of both, a bronchoprovocation may be required to make the diagnosis.
The differentiation of asthma from other diseases associated with dyspnea and wheezing is usually not difficult, particularly if the patient is seen during an acute episode.
They physical findings and symptoms listed above and the history of periodic attacks are quite characteristic. A personal or family history of allergic diseases such as eczema, rhinitis or urticaria is valuable contributory evidence.
An extremely common feature of asthma is nocturnal awakening with dyspnea and / or wheezing. In fact, this phenomenon is so prevalent that its absence makes one doubt the correctness of the diagnosis.
Upper airway obstruction by tumour or laryngeal edema can occasionally be confused with asthma. Typically, such a patient will present with stridor, and the harsh respiratory sounds can be localized to the area of the trachea.
wheezing throughout both lung fields is usually absent. However, differentiation
can sometimes be difficult, and indirect laryngoscopy
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