Author: Leia Kessler, MD

Editors: David Guernsey, MD, Ellen Duncan, MD/PHD

Introduction:

• Asthma is a chronic inflammatory airway disease characterized by reversible lower airway obstruction due to bronchoconstriction, mucosal edema, and mucus plugging
• Common triggers include viral respiratory infections, exercise, and allergen exposure.
• Asthma is one of the most common chronic pediatric conditions and a leading cause of emergency department (ED) visits and hospitalizations.

• Early recognition and management of exacerbations is essential to prevent life-threatening complications such as respiratory failure, cardiopulmonary arrest, and death. Clinical Manifestations:

• Patients typically present with a combination of:

  • Shortness of breath
  • Wheezing
  • Chest tightness
  • Cough (especially nocturnal or triggered by exercise)
• Risk factors for severe disease and asthma-related mortality include:
  • Prior ICU admission or need for respiratory support (i.e., HFNC, BiPAP, or intubation)
  • Frequent ED visits or hospitalizations for asthma
  • Poor symptom perception, incorrect inhaler technique, or nonadherence to controller medications
• Vital sign abnormalities may include tachypnea, tachycardia, and/or hypoxemia; because asthma is an obstructive disease of the lower airways, significant hypoxemia (SaO2<92%) suggests marked airflow limitation and impaired gas exchange
• Patients may have inspiratory, expiratory, or biphasic wheeze; while expiratory wheeze typically indicates mild-moderate obstruction, inspiratory and/or biphasic wheeze suggest more significant airflow limitation.
• Absence of wheeze (“silent chest”) reflects critically reduced airflow, worsening of obstruction, and impending respiratory failure.

| Physical Exam Findings | | Mild/Moderate | Severe | | Wheezing | Tripod position |