Asthma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Lakshmi Gopalakrishnan, M.B.B.S. [2]

## Overview[edit | edit source]

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[edit | edit source]

Physical examination may be normal or can be characteristically present with a loud polyphonic expiratory wheeze.[1][2]

### Vitals[edit | edit source]

#### Pulse[edit | edit source]

##### Rate[edit | edit source]

* Increased heart rate in acute severe episode

##### Strength[edit | edit source]

* 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[edit | edit source]

* Increased respiratory rate greater than 30 cycles per minute in moderately severe and acute severe episodes

### Skin[edit | edit source]

* Profuse sweating in imminent respiratory failure
* Severe hypoxia resulting in central cyanosis and hypoventilation in imminent respiratory failure

### Eyes[edit | edit source]

* Conjunctival congestion as a consequence of constant rubbing are suggestive of associated allergic rhinitis.

### Nose[edit | edit source]

* 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[edit | edit source]

#### Mild Episode[edit | edit source]

* Prolong end-expiratory wheeze
* In between attacks, chest is clear and no abnormal physical signs may be detectable.

#### Moderately Severe Episode[edit | edit source]

* 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[edit | edit source]

* 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[edit | edit source]

* 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[edit | edit source]

* Persistent scattered rhonchi

### Other Associated Findings[edit | edit source]

* 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[edit | edit source]

1. ↑ 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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
2. ↑ 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.CS1 maint: Multiple names: authors list (link)

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