intermittent wheezing, coughing and breathlessness
trigger factors
symptoms usually follow a diurnal pattern; a nocturnal cough may be the only symptom
the patient may complain of a morning tightness and wheezing that occurs usually within seconds of wakening and may take minutes or hours to resolve.
characteristically asthmatics suffer early morning attacks - morning dips. These may occur in the early hours, e.g. 3 or 4 am, and the patient may wake with tightness, cough and wheezing. These attacks may be confused with paroxysmal nocturnal dyspnoea due to left ventricular failure. The symptom of nocturnal chest tightness is a diagnostic pointer to asthma.
Between attacks:
may be no signs
may be signs of chronic asthma like Harrison's sulcus
may be features of Churg-Strauss syndrome, i.e. nasal polyps and skin rashes
During an attack:
decreased peak flow
tachypnoea
use of accessory muscles of respiration
hyperinflation, barrel chest
prolonged expiration
on auscultation there are a widespread polyphonic, high pitched wheezes
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