Bronchial Asthma: Symptoms, Complaints, Signs

Typical is the occurrence of the so-called asthma triad, consisting of:

  1. Bronchospasm – spasm of the bronchi with associated increase in bronchial musculature.
  2. Mucosal swelling with infiltration of so-called eosinophilic granulocytes.
  3. Dyscrinia – thickening of the bronchial mucus.

Other complaints may include:

  • Dyspnea – shortness of breath, shortness of breath, possibly forcing to sit up and support (orthopnea) (patients also speak here of “tightness in the chest” or “chest tightness”).
  • Coughing fits 1,2, especially at night.
  • Dry rales – giemen 2 (wheezing): bilateral, ubiquitous prolonged expiratory (prolonged expiratory time).
  • Tough expectoration
  • Tightness in the chest
  • Prolonged expiratory (prolonged exhalation).
  • Hypersonoric knocking sound
  • Decrease in second capacity
  • Decrease in vital capacity
  • Increase in residual volume
  • In severe cases, status asthmaticus may develop, a consequence of asthma attacks culminating in a continuous spasm. These can last for hours, possibly days and can be life-threatening
  • Central cyanosis (blue coloration of the skin and mucous membranes / tongue).

1 Increased cough frequency is an indicator of more severe and difficult-to-control disease. Note: A group of patients in whom asthma diagnosis is often missed or delayed is patients with “cough-variant asthma” (cough type asthma, cough as asthma equivalent). 2 An indicator of the onset of school-age asthma or independent risk factor is giezing (“wheezing”) followed by nocturnal irritable cough (i.e., nonproductive cough). Characteristic of bronchial asthma is that the above symptoms occur intermittently and the patient is symptom-free between attacks. Severe dyspnea results in the following clinical findings:

  • Orthopnea (most severe form of dyspnea requiring use of auxiliary respiratory muscles in an upright position).
  • Intercostal (“between the ribs“) or supraclavicular (“above the clavicle”) retractions.
  • Speech dyspnea (shortness of breath when speaking).
  • Tachypnea (increased respiratory rate) > 25/min
  • Tachycardia (increased heart rate) > 110/min

Differentiation of bronchial asthma and chronic obstructive pulmonary disease (COPD)

Age < 40 years 0 points
40-60 years 2 points
> 60 years 4 points
Persistent shortness of breath No: 0 points Yes: 1 point
Diurnal variation of shortness of breath. Yes: 0 points No: 1 point
Changes in pulmonary emphysema No: 0 points Yes: 1 point

Assessment:

  • 0-2 points: Probability of bronchial asthma
  • 3-4 points: difficult to differentiate
  • 5 to 7 points: Probability of COPD

The severely threatening asthma attack

  • Increasing dyspnea and increased work of breathing (“chest tightness”): prolonged expiration, possibly with use of auxiliary respiratory muscles; possibly speech dyspnea (severe form of shortness of breath (dyspnea) triggered by the effort of speech alone).
  • Whistling breath sound (“giemen”)Note: Whistling breath sounds may be completely absent in severe exacerbations (marked worsening of the clinical picture) (“silent lung“).
  • Cough
  • Alarm signs: Cyanosis (blue discoloration of the skin) or mental symptoms such as agitation (morbid restlessness), confusion; exhaustion.

Warning signs (red flags) in adults

  • Medical history:
    • Admitted as an inpatient due to asthma exacerbation.
    • Life-threatening (“near fatal”) asthma attack.
    • Medication:
      • Excessive use of beta-2 agonists
      • Ongoing or recently discontinued systemic steroid therapy
      • Insufficient compliance with therapy
  • Bradypnea (breathing too slow: < 10/min) + increasingly shallow, frustrated breathing → immediate intubation and mechanical processing.
  • Bradycardia (heartbeat too slow: < 60 beats per minute) + increasingly shallow, frustrated breathing → immediate intubation and mechanical processing
  • Respiratory global insufficiency (highly impaired pulmonary function) with hypercapnic coma (elevated blood carbon dioxide levels resulting from inadequate ventilation) → immediate intubation and mechanical treatment

Warning signs (red flags) in young children

  • Nose wings
  • Groan
  • Paleness
  • Lethargy
  • Difficulty talking, feeding, playing.

Gender differences (gender medicine)

  • Boys (up to age 12 years): suffer from dyspnea (shortness of breath) more often than girls; after adolescence, this reverses (due toFemales have a lower average vital capacity or one-second capacity)4
  • Relative to an identical lung function, that is, “asthma severity,” women suffer more dyspnea (shortness of breath) than men.
  • Approximately 20% of all female asthmatics suffer from perimenstrual asthma (PMA), i.e. around the time of menstruation.