Introduction
A patient with symptoms of asthma usually gives a history of recurrent breathing problems (dyspnea) and shortness of breath, the dyspnea is usually worse at night and the patient may have to prop up in bed or sleep the remainder of the night in a sitting position.
The breathing problems may start along with a cold so that it seems that the patient simply did not recover from the cold. Along with the attack is a lot of coughing and this seems to be the only way to get a deeper breath of air. The way this can be explained is that due to the bronchoconstriction (=spasm of the air tubes) air gets trapped in the air sacs (called alveoli) and only coughing squeezes the air out to a certain extent.
Symptoms Of Asthma
The problem with asthma is that due to bronchiolitis the air gets trapped and proper oxygen/carbon dioxide exchange cannot occur. As explained above, the physician can readily hear this as wheezing with the help of the stethoscope. But with an asthma attack an observant person standing near-by can often hear the wheezing also as can the patient.
A chronic cough is another symptom that often occurs, made worse with exercise or brought on by cold air. Parents are not infrequently the ones who pick up on this with a child that might cough in the sleep, but may be relatively OK during the day. If the physician measures the PEF with a peak flow meter, this can show at this point in time very often that early mild intermittent asthma is present.
References:
1. Noble: Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc.
2. National Asthma Education and Prevention Program. Expert Panel Report II. National Heart, Lung and Blood Institute, 1997.
3. Rakel: Conn’s Current Therapy 2002, 54th ed., Copyright © 2002 W. B. Saunders Company
4. Murray & Nadel: Textbook of Respiratory Medicine, 3rd ed., Copyright © 2000 W. B. Saunders Company
5. Behrman: Nelson Textbook of Pediatrics, 16th ed., Copyright © 2000 W. B. Saunders Company
6. Merck Manual: Asthma (thanks to http://www.merckmanuals.com for this link)
7. Goldman: Cecil Textbook of Medicine, 21st ed., Copyright © 2000 W. B. Saunders Company
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
9. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
