Now, your patient with asthma may
come in with a chronic cough,
or they may just cough after exercise,
or they might have a nocturnal
cough or a nighttime cough.
Your patient may describe wheezing
and this is the turbulent air flow
through their tightened airway.
Imagine a fireplace, and when
the wind is blowing outside
and it gets turbulent, you hear
a whistling in the fireplace.
This is the same thing that
happens in the airway.
The patient's going to have
increased sputum production.
They may have chest pain, and they
will have difficulty breathing.
Signs and symptoms associated
with an asthma emergency
include if your patient's
symptoms do not resolve.
So we give patients about
a 15-30 minute window
to try their asthma action plan
to try to reverse their symptoms,
and if it doesn't work, they
need to seek medical attention.
Status asthmaticus can be life-threatening.
On exam, the clinician will use information
obtained in their health history
and physical exam to help diagnose
and treat a patient with asthma.
There are a lot of components
of information to gather
for a complete health-history
in regard to asthma.
These include asking the
patient about their symptoms,
including their cough, whether
or not they're wheezing,
do they experience shortness
of breath, chest tightness,
and are they having a productive cough?
The second is the pattern of their symptoms.
Is this perennial, is this
seasonal, or is it both?
Is this continual or episodic, or both?
And talk about the onset.
When did these symptoms start?
The duration, how long have they lasted?
And frequency, how often do they happen?
Number of nights per week or
number of nights per month.
Are there any diurnal variations,
especially at night and on awakening?
The third part of the health
history involves precipitating
or aggravating factors.
And this could be the
patient saying, you know,
"Every time I get a cold, I end
up with asthma-type symptoms,"
and this would be a viral
respiratory infection trigger.
Does your patient have environmental
allergen triggers, indoor or outdoor?
Sometimes they'll go mow the grass and
then come in and say they're wheezing.
Well, they might have a grass allergy
that's triggering their asthma.
You want to ask about the
characteristics of their home,
including the age of their
home, the location,
how do they heat and cool their home,
and do they have any carpet?
You'll want to ask about pets in the
home as these are common triggers.
You want to ask if there's
any smoking in the home,
and does this happen after
the patient exercises?
Sometimes, patients will say after
they get emotional or stressed,
this will trigger their asthma attack.
And sometimes, they'll say it's after
they take certain medications.
Perhaps, a change in the weather
or an exposure to cold air
will also trigger their symptoms.
Or they might have comorbid conditions.
Maybe they have GERD,
which is gastroesophageal reflux
disease or heartburn.
Or maybe they have chronic sinusitis,
and these conditions need to be handled
to get their asthma under control.
The fourth part of the health history
is the development of their
disease and treatment.
So, how old were they when this started,
and have they been formally
diagnosed with asthma?
Do they have any history of early
life injury to the airways?
And those are those viruses we talked about
that can cause long-term problems
in the airway remodeling.
How was the progression of their disease?
Has it gotten better?
Has it gotten worse with time?
And how do they manage
their current symptoms?
If they do have albuterol, or a
short-acting beta-2 agonist,
you want to ask how often are
they needing that medication?
And then you also want to ask have they
had a need for oral corticosteroids
and how often have they needed those?
The fifth component is collecting a family
history because we know this is familial.
Is there any family history of
asthma or allergic conditions,
frequent or chronic sinusitis,
rhinitis, which is a runny nose,
can be linked with allergies, eczema,
or nasal polyps in close relatives.
All of these conditions
are linked with asthma.
And how about their social history?
Does the patient attend daycare?
Is their workplace having any triggers,
and are there any known school triggers?
Then you want to ask about their
social and support networks
because this is a chronic condition.
Next, you want to ask about
the history of exacerbations.
Does your patient have a usual
prodromal sign or symptom
to know that their asthma attack is coming?
How about the rapidity of onset?
Does this happen fast for a patient?
The duration and frequency
of their exacerbations.
And at the severity.
Does this patient typically
manage this at home?
Do they need to go into
an urgent care setting?
Do they need to go to the
Or have they even been managed
in the intensive care unit?
And you'll always want to ask about
has this patient had any
This lets you know that their
asthma may be fragile.
Have they been intubated or managed in the
intensive care setting with their asthma?
The eighth component is the impact of
asthma on their patient and family care.
Do they have episodes of unscheduled care?
Are they missing work?
Are they missing school?
Does this limit their activities,
especially their sports,
because this is a component
of the quality of life?
These patients really want to
get back to their activities.
Are they up at night with their cough
and managing their asthma symptoms,
because this is going to
affect their level of rest?
And ultimately, what is the effect on their
growth and development and behavior,
school performance and lifestyle
because this is a chronic condition,
and it can disrupt the patient's
life quite significantly.
Next, you want to do an
assessment of the patient
and family's perception of the disease.
Do they have knowledge of asthma and
understand the efficacy of treatment?
I see a lot of patients that won't
take their chronic asthma medications
because on a day by day basis,
they're not having many symptoms.
But when I explained that
uncontrolled chronic asthma
can actually permanently remodel the airway
and make it an irreversible disease,
they start taking their treatment.
The ability of a patient and
parent to cope with the disease,
the level of family support,
and the ability to recognize the
severity of an asthma exacerbation.
The economic resources available.
So, inhalers are expensive and a
lot of patients can't afford them.
There are vouchers available to be able
to get these inhalers for your patients.
And what are your patients sociocultural
beliefs regarding asthma?