EpistemisGeneralized and changing expiratory wheezing
Specialty: Respiratory.
Why it occurs
- Exacerbated intermittent or persistent bronchial asthma (auscultation reveals multiple wheezes of different tones (polyphonic) distributed throughout both lung fields, which vary in location and intensity after cough or after the administration of bronchodilators, due to inflammation and heterogeneous and reversible bronchoconstriction of the airway)
- Acute viral or bacterial bronchitis in a patient with transient bronchial hyperreactivity
- Reactive bronchospastic reaction due to exposure to sudden changes in temperature or inhalation of intense perfumes
- Reacerbated COPD with associated asthmatic component (asthma-COPD overlap syndrome or ACO).
Initial workup
Pre- and post-bronchodilator forced spirometry (demonstration of a reversible obstructive pattern with an increase in FEV1 greater than or equal to 12% and 200 mL); Measurement of maximum expiratory flow (Peak Flow) at home; Chest x-ray (rule out pneumonia or pneumothorax as triggers of the crisis).
red flags
Abrupt decrease in the intensity of wheezing accompanied by worsening dyspnea and drowsiness (indicates muscle fatigue and severe hypoventilation, with risk of respiratory arrest, known as "silent chest"), inability to speak consecutive sentences, or extreme use of the accessory muscles of the neck.
Standard management
- Salbutamol — 100-200 micrograms inhaled through an inhalation chamber, being able to repeat up to 4-10 puffs every 20 minutes during the first hour in a moderate crisis
- Budesonide/Formoterol — 160/4.5 micrograms inhaled, SMART maintenance and rescue regimen
- Prednisone (40-50 mg orally daily for 5-7 days as rescue systemic corticosteroid therapy).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 4
- Treatment options
- 3