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post in: Lifestyle, Video Date:08 Oct 2017, 14:53 views:4375
A detailed assessment of the medical history should address the following: Whether symptoms are attributable to asthma.
Whether findings support the likelihood of asthma (eg, family history). Asthma severity, identification of possible precipitating factors, family history may be pertinent for asthma, allergy, sinusitis, rhinitis, eczema, and asthma nasal polyps.
The social history may include home characteristics, smoking, workplace or school characteristics, educational level, employment, social support, factors that may contribute to nonadherence of asthma medications, and illicit drug use. The patients exacerbation history is important with respect to the following: Usual prodromal signs or symptoms. Rapidity of onset, associated illnesses, number in the last year, need for emergency department visits, hospitalizations, ICU admissions, intubations.
Missed days from work or school or activity limitation. The patients perception of his or her asthma is important regarding knowledge of asthma and treatment, use of medications, coping mechanisms, family support, and economic resources. General manifestations of asthma, wheezing, a musical, high-pitched, whistling sound produced by airflow turbulence, is one of the most common symptoms.
In the mildest form, wheezing is only end expiratory.
As severity increases, the wheeze lasts throughout expiration. In a more severe asthmatic episode, wheezing is also present during inspiration. During a most severe episode, wheezing may be absent because of the severe limitation of airflow associated with airway narrowing and respiratory muscle fatigue.
Asthma can occur without wheezing when obstruction involves predominantly the small airways.
Thus, wheezing is not necessary for the diagnosis of asthma. Furthermore, wheezing can be associated with other causes of airway obstruction, such as cystic fibrosis and heart failure. Patients with vocal cord dysfunction, now referred to as inducible laryngeal obstruction (ILO have a predominantly inspiratory monophonic wheeze (different from the polyphonic wheeze in asthma which is heard best over the laryngeal area in the neck.
Patients with excessive dynamic airway collapse (edac bronchomalacia, or tracheomalacia also have an expiratory monophonic wheeze heard over the large airways. In exercise-induced bronchoconstriction, wheezing may be present after exercise, and in nocturnal asthma, wheezing is present during the night.
Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma.