Asthma without Cough

Diagnose if detecting wheezes, rhonchi, or just a long expiratory phase (i.e. expiration longer than inspiration.  Strongly suspect if there’s a history of similar episodes lasting weeks or more.

Confirm with a trial of inhaled β-2 agonist (e.g. albuterol), nebulized in the office, and/or by inhaler to take home.  Look for improvement in symptoms & in Peak Flow.

May need formal PFTs to make the diagnosis (looking for a reduced FEV1 : FVC ratio, that improves >15% with nebulized β-2 agonist.  Methacholine challenge test is the gold standard.

Can diagnose Exercise-Induced Asthma by β-2 agonist before exertion, or trial of a daily leukotriene antagonist like monteleukast (Singulair).  Formal pulmonary function tests after a treadmill session can be done, but rarely utilized.

Main pitfall is “cardiac asthma” (CHF presenting with wheezes instead of rales).

See posting Chronic Dyspnea – 1.