Last reviewed: August 2020
Last updated: July  2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cough
  • wheezing
  • shortness of breath
  • chest tightness
  • sleep disturbance
  • accessory muscle use
  • tachypnoea
  • tachycardia
  • wheezing, poor air movement, or diminished breath sounds
  • inability to speak

Other diagnostic factors

  • exercise limitation
  • stridor
  • cyanosis

Risk factors

  • viral infection
  • uncontrolled asthma symptoms
  • high use of short-acting beta-2 agonists
  • inadequate use of inhaled corticosteroids
  • incorrect inhaler technique
  • low forced expiratory volume in 1 second (FEV₁)
  • high bronchodilator reversibility
  • current smoker or exposure to second-hand cigarette smoke
  • exposure to allergens (including history of seasonal allergic rhinitis)
  • atopic eczema
  • air pollution
  • poor indoor air quality
  • obesity
  • chronic rhinosinusitis
  • gastro-oesophageal reflux disease
  • confirmed food allergy
  • history of asthma
  • history of hospitalisation for asthma exacerbations
  • one or more severe exacerbations in the last 12 months
  • use of oral corticosteroids
  • poor adherence to asthma treatment
  • pregnancy
  • blood eosinophils
  • elevated fractional exhaled nitric oxide (FeNO)
  • respiratory bacterial infection

Diagnostic investigations

Treatment algorithm

Contributors

Clinical Assistant Professor (Affiliated)

Division of Pulmonary, Allergy and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

CA

Disclosures

SM declares that he has no competing interests.

Fellow

Division of Pulmonary, Allergy and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

CA

Disclosures

LE declares that she has no competing interests.

Dr Sourav Majumdar and Dr Lauren Eggert would like to gratefully acknowledge Dr Ware Kuschner, Dr Michael Ezzie, and Dr Jonathan P. Parsons, the previous contributors to this topic.

Peer reviewersVIEW ALL

Assistant Professor

Pulmonary and Critical Care Medicine

University of Vermont

Burlington

VT

Disclosures

AD declares that she has no competing interests.

Professor of Respiratory Medicine

Institute of Infection, Immunity & Inflammation

University of Glasgow

Glasgow

Scotland

UK

Disclosures

NCT declares that he has no competing interests.

Consultant Chest Physician

Chest Clinic C

Aberdeen Royal Infirmary

Aberdeen

Scotland

UK

Disclosures

GPC declares that he has no competing interests.

Use of this content is subject to our disclaimer