3. Asthma Presentation

Clinical signs and symptoms of asthma can vary between patients and even within the same patient. When well, there may be no signs or symptoms. During an asthma exacerbation, hyperinflation of chest wall, cough, expiratory polyphonic wheezing, prolonged expiratory phase. In severe exacerbation, there may only be inspiratory phase heard and no expiratory wheezing. Chest x-rays may be clear or show hyper-expansion.

Increased probability that symptoms are due to asthma if:
 

• More than one type of symptom (wheeze, shortness of breath, cough, chest tightness) 
  
  
• Symptoms often worse at night or in the early morning
  
  
• Symptoms vary over time and in intensity 
  
  
• Symptoms are triggered by viral infections, exercise, allergen exposure, changes in weather, laughter, irritants such as car exhaust fumes, smoke, or strong smells 

Decreased probability that symptoms are due to asthma if:
 

• Isolated cough with no other respiratory symptoms 
  
  
• Chronic production of sputum 
  
  
• Shortness of breath associated with dizziness, light-headedness or peripheral tingling 
  
  
• Chest pain 
  
  
• Exercise-induced dyspnea with noisy inspiration (stridor) 

Other aspects of history and physical may provide additional information to classify asthma phenotypes and endotypes:

• Pattern: seasonality, continuous vs. episodic, character (onset, duration, frequency), triggers
  
  
• Development: age at onset, airway injury, progression, current management 
  
  
• Family history: atopy, asthma, other 
  
  
• Social: environment, siblings, daycare 
  
  
• Impact on family: emergency visits, lost work or school, activity limitations, economic, patient and family perception
  
  
• Cellular patterns: eosinophilic, neutrophilic, mixed cellular inflammation, pauci-immune 
  
  
• Response to previous therapies