Fast Five Quiz: Test Your Knowledge of Severe Asthma

Zab Mosenifar, MD

Disclosures

July 26, 2019

In a moderately severe asthma episode, the respiratory rate also is increased. Typically, accessory muscles of respiration are used. In children, also look for supraclavicular and intercostal retractions and nasal flaring, as well as abdominal breathing. The heart rate is 100-120 beats/min. Loud expiratory wheezing can be heard, and pulsus paradoxus may be present (10-20 mm Hg). Oxyhemoglobin saturation with room air is 91%-95%. Patients experiencing a moderately severe episode are breathless while talking, and infants have feeding difficulties and a softer, shorter cry. In more severe cases, the patient assumes a sitting position.

In a severe asthma episode, patients are breathless during rest, are not interested in eating, sit upright, talk in words rather than sentences, and are usually agitated. In a severe episode, the respiratory rate is often > 30 breaths/min. Accessory muscles of respiration are usually used, and suprasternal retractions are commonly present. The heart rate is > 120 beats/min. Loud biphasic (expiratory and inspiratory) wheezing can be heard, and pulsus paradoxus is often present (20-40 mm Hg). Oxyhemoglobin saturation with room air is less than 91%. As the severity increases, the patient increasingly assumes a hunched-over sitting position with the hands supporting the torso, termed the "tripod position."

For more on the presentation of a severe asthma episode, read here.

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