Summary
Definition
History and exam
Key diagnostic factors
- cough
- wheezing
- shortness of breath
- chest tightness
- sleep disturbance
- accessory muscle use
- tachypnea
- tachycardia
- wheezing, poor air movement, or diminished breath sounds
- inability to speak
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 secondhand cigarette smoke
- exposure to allergens (including history of seasonal allergic rhinitis)
- atopic eczema
- air pollution
- poor indoor air quality
- obesity
- chronic rhinosinusitis
- gastroesophageal reflux disease
- confirmed food allergy
- history of asthma
- history of hospitalization 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
1st investigations to order
- peak expiratory flow rate
- oxygen saturation
Treatment algorithm
Contributors
Authors
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.
Clinical Assistant Professor
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.
Disclosures
WK and ME declare that they have no competing interests. JPP is a member of Speakers' Bureaus for GlaxoSmithKline, Inc.; Schering-Plough, Inc.; and AstraZeneca, Inc.
Peer reviewers
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