Common cases in respiratory medicine: acute severe asthma
This article describes the approach to the ward round in our fourth patient, Miss Adams, who has acute severe asthma
Elizabeth Adams is a 20 year old woman with a history of asthma who was brought to hospital by ambulance after an episode of breathlessness and wheezing. It is the day after her admission. You review her admission notes before the ward round.
Exacerbations of asthma are often triggered by exercise, exposure to allergens (such as pet hair, grass pollen, house dust mite), and exposure to cold air.1 From Miss Adams’ history you can see evidence of two of these triggers and that she also has hay fever and eczema. These conditions are related to asthma because they have similar causes. People who have a combination of these diseases are often said to be atopic.
When you review the examination section of the clerking documentation you see that on arrival to hospital Miss Adams was very breathless and agitated at rest and was using her accessory muscles to breathe. Her