So if you are examining a child
who you suspect have asthma,
it’s important, first off, to
note their overall appearance
and whether they have
In a child with asthma who
is in respiratory distress,
we are going to first address
their respiratory distress
and later ask the question
about whether maybe
this isn’t asthma or
some other disease.
In other words, the typical
paradigm you'll learn of
what’s the differential diagnosis and
now how do we manage the patient
is put on hold in asthma
because we may not have time
to address their differential diagnosis.
First, we need to jump to what
is what’s most concerning.
Because asthma represents by far and away the
most common cause of wheeze in children,
we’re going to just address
their asthma first
if they’re in grave respiratory
distress and do studies later.
We’re going to check their respiratory
rate and their lung exam.
Very important to know
what is that sound
Is there air entry throughout?
Is there wheezing throughout?
Is it inspiratory and expiratory wheezing?
Do they have rhonchi, which
might be bronchiolitis?
Or do they have crackles,
which might be pneumonia?
This will help us distinguish these things.
It’s important to note their heart
rate and their cardiac exam
keeping in mind that
albuterol, once it’s given,
is absolutely going to cause tachycardia
as a side effect of the drug.
But if they’re having a high heart rate,
it may be because they’re
afraid or they have air hunger,
but it may also because they’re
having problems with oxygenation.
It’s important to examine
the liver in an asthmatic
and that might not seem totally
obvious right off the bat.
But remember, in asthma, the
problem is getting the air out.
It’s obstructive lung disease.
These patients are hyperinflated
and it would be very unusual
to fail to appreciate a liver.
In other words, if you put your
hands under the right lower --
right upper quadrant, you should
feel a liver edge in an asthmatic
who’s having an exacerbation.
So expect a little bit of a
liver edge in these children.
It’s helpful to find
things like hives or eczema or other
findings in a patient with asthma.
If you see clubbing or failure
to thrive, that is not asthma.
Something else is going on
and you need to figure out what is the
cause of this pulmonary situation.
So those are the key physical exam
findings we’re going to look for.