Complaints and Clinical Findings of Asthma
Primary Symptoms
Asthma presents with four cardinal symptoms that are variable, intermittent, worse at night, and provoked by triggers including exercise 1, 2:
- Wheeze - the most characteristic finding 1
- Shortness of breath 1, 3
- Chest tightness 1, 3
- Cough - variable and intermittent, not continuous 1, 2
The hallmark feature distinguishing asthma from other respiratory conditions is that these symptoms are variable, intermittent, worse at night, and provoked by triggers including exercise 1, 2. This pattern is more diagnostically significant than any individual symptom.
Clinical Signs During Examination
During Acute Episodes/Exacerbations
Wheeze is the cardinal physical finding and should be documented when present 1:
- Diffuse, polyphonic, bilateral wheeze - particularly expiratory 1
- Reduced lung function - decreased peak flow or obstructive pattern on spirometry 1
- Accessory muscle use 4
- Tachycardia - pulse >120 beats/min suggests severe obstruction 4
- Pulsus paradoxus 4
- Decreased breath sounds in severe cases 4
Between Episodes
Outside acute episodes, there may be no objective signs of asthma 1. This is a critical pitfall - normal examination between episodes does not exclude asthma. Patients with chronic asthma may show signs of hyperinflation with or without wheeze 1.
Characteristic Patterns and Triggers
Symptom Triggers
Exercise-induced wheezing is highly characteristic of asthma 2:
- Exercise 1, 2
- Viral upper respiratory infections 5, 3, 6
- Allergen exposure (pollens, dust, feathered or furry animals) 1
- Environmental tobacco smoke 1
- Cold air 7
- Chemicals and irritants 1, 7
- Aspirin/NSAIDs in susceptible patients 1
- Beta-blockers 1
Temporal Patterns
- Nocturnal worsening is characteristic 1
- Diurnal variability in symptoms and airflow 5
- Episodic nature - symptoms come and go rather than being continuous 1, 3
Additional Clinical Information
History Features Supporting Asthma Diagnosis
- Personal or family history of atopy (eczema, allergic rhinitis) 1, 6
- Response to bronchodilators 1
- Previous emergency department visits or hospitalizations 5, 4
- History of near-fatal asthma episodes 5
Cough Variant Asthma
When cough is the predominant symptom without wheeze, this is referred to as cough variant asthma 1, 3. This is a nonproductive cough that responds to asthma treatment but not to antibiotics, expectorants, or antitussives 3.
Important Caveats
Continuous productive cough is NOT characteristic of asthma and suggests alternative diagnoses like bronchiectasis, COPD, or chronic bronchitis 2.
Recurrent respiratory infections are NOT characteristic of asthma and should prompt consideration of bronchiectasis, cystic fibrosis, or immunodeficiency 2.
None of these symptoms are specific for asthma - they can occur in other respiratory conditions 1. The diagnosis requires correlation with objective testing showing variable airflow limitation 1.
Objective Findings
Measurement of airflow limitation is essential to corroborate symptoms 1: