Asthma / COPD Exacerbation

  • Cough
  • Dyspnea
    • Doubt Dx if SOB without Cough
    • Exercise-Induced Asthma may present w/ SOB alone

Main clue  — any (or all) of the following Abnormal Lung Sounds (bilaterally):

  • Wheezes (long, high-pitched, expiratory)
  • Rhonchi (long or short, high- or low-pitched, inspiratory &/or expiratory squeaks & gurgles)
  • Expiratory Phase longer than Inspiratory (“E > I”, which is the opposite of a normal exam)
Suspect if there’s a history of frequent prior episodes
  • especially if they lasted >3 weeks (too long for simple viruses)
Give Nebulized Albuterol, 2-3 treatments (15 min. pause in between)
  • Test Peak Flow before & after
  • Dx “bronchospasm” (“reversible airways disease”) if:
    • Peak Flow improves; OR
    • Abnormal lung findings normalize; OR
    • Patient feels lots better
If first-ever episode, Dx “Acute Bronchitis” instead of “asthma”
  • Rx inhaled bronchodilators (e.g. albuterol)
  • If no help, maybe add “controller meds” [inhaled steroids, etc]
  • Don’t give Dx “asthma” until future episodes set a pattern
  • Post-inflammatory bronchospasm can last months after a viral respiratory infection
Chronic Bronchitis is a disease of smokers.
  • Dx as above; Tx with inhaled anticholinegics
  • If exacerbation includes purulent sputum (as seen objectively by you), may also need antibiotics

See postings Acute Dyspnea – 3 and Acute Cough – 2.