From the Guidelines
Congestive heart failure (CHF) exacerbation and asthma exacerbation present with distinct symptom patterns that help differentiate these conditions, with CHF typically manifesting with progressive shortness of breath, orthopnea, and peripheral edema, while asthma exacerbation presents with sudden onset of wheezing, chest tightness, and decreased peak flow measurements, as noted in studies such as 1 and 2. The symptoms of CHF exacerbation include:
- Progressive shortness of breath
- Orthopnea (difficulty breathing when lying flat)
- Paroxysmal nocturnal dyspnea (waking up breathless at night)
- Peripheral edema (swelling in legs and ankles)
- Fatigue
- Weight gain due to fluid retention
- A cough that may produce frothy, pink-tinged sputum In contrast, asthma exacerbation presents with:
- Sudden onset of wheezing
- Chest tightness
- Coughing (often worse at night or early morning)
- Shortness of breath
- Decreased peak flow measurements Asthma patients typically have a normal cardiac exam, exhibit diffuse wheezing on auscultation, and may demonstrate prolonged expiration and use of accessory muscles, as discussed in 3 and 4. The timing of symptoms also differs, with CHF symptoms typically developing gradually over days to weeks, while asthma attacks often occur suddenly, sometimes triggered by specific allergens, exercise, or respiratory infections, as noted in 5 and 6. Response to treatment provides another clue: asthma typically improves with bronchodilators like albuterol, while CHF responds to diuretics like furosemide, as discussed in 7 and 8. Understanding these distinctions is crucial for proper diagnosis and management of these potentially life-threatening conditions.
From the Research
Symptoms of CHF Exacerbation vs Asthma Exacerbation
- Dyspnea is a common symptom in both CHF and asthma exacerbations 9
- Orthopnea and nocturnal cough can be present in both conditions, making differential diagnosis challenging 9
- Exercise intolerance and muscle weakness may also coexist in both pathologies 9
Diagnostic Considerations
- Natriuretic peptides, such as Brain Natriuretic Peptide (BNP) and N-terminal-pro Brain Natriuretic Peptide (NT-proBNP), are sensitive biomarkers for HF and can help exclude HF if values are below certain thresholds 9
- Echocardiography is the standard imaging technique for HF diagnosis and should be performed in all patients with potential HF 9
Treatment Considerations
- Treatment of CHF exacerbations may involve intravenous diuretics, nitroglycerin, and noninvasive positive pressure ventilation, depending on the severity of the exacerbation 10
- Inhaled beta-2 agonists, commonly used to treat asthma exacerbations, may also be beneficial in patients with CHF, with some studies suggesting improved pulmonary function and cardiovascular hemodynamics 11
- However, the use of beta-2 agonists in CHF patients should be approached with caution, as chronic administration has been associated with increased adverse events 11