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  4. how to diagnose and differentiate status of asthma-status of asthma can easily confuse disease

how to diagnose and differentiate status of asthma-status of asthma can easily confuse disease

how to diagnose and differentiate status of asthma-status of asthma can easily confuse disease

Asthma patients do not necessarily show signs of wheezing. On the contrary, if they have wheezing and dyspnea, they may not be diagnosed as asthma. They need to be differentiated from the following diseases.

1. In the early stage of cardiogenic asthma, left ventricular insufficiency often presents night-time episodes of dyspnea, accompanied by expiratory wheezing, the symptoms resemble bronchial asthma. Such patients often have obvious history and signs of heart disease, most of them are sitting breathing, and may have signs such as diffuse rales at the bottom of both lungs. When identification is difficult, selective β2 receptor stimulants can be inhaled for diagnostic treatment.

2. Spontaneous pneumothorax is a pneumothorax that appears on the basis of chronic obstructive pulmonary disease. The signs of pneumothorax are often not obvious, but it is manifested as sudden dyspnea. Some patients have expiratory wheeze (especially on the opposite side of the pneumothorax), which is clinically easily confused with asthma. It is necessary to be more vigilant, and those who are suspicious should undergo X-ray examination as soon as possible to confirm the diagnosis.

3. Obstructive diseases of the airway. Tumors, foreign bodies, inflammation and congenital abnormalities can cause blockage of the larynx, glottis, trachea or main bronchus (intraluminal or external pressure), causing dyspnea and wheezing. But this kind of wheezing is often particularly pronounced in a certain part, mostly biphasic wheezing dominated by inspiration, often accompanied by abnormal thickening of bronchial breath sounds at the base of both lungs. Laryngeal examination, X-ray tracheal frontal tomography and fiberoptic bronchial examination can confirm the diagnosis.

4. Exogenous allergic alveolitis This disease can have typical asthma symptoms, but these patients often have a history of exposure to allergens (subtilis, pigeon droppings, etc.), and the X-ray chest film shows diffuse pulmonary interstitial lesions in patches. Like infiltration, blood eosinophils are significantly increased, which is helpful for identification.

5. Patients with acute and chronic bronchitis may have wheezing and dyspnea, while asthmatic patients may have no wheezing but only paroxysmal dry cough. It is sometimes difficult to identify clinically. However, the symptoms of bronchitis patients do not have episodic features. Chronic bronchitis has a long-term chronic cough, and bronchitis usually produces more sputum. Inhalation test of bronchodilator or determination of circadian PEF fluctuation rate is helpful for identification.

6. Allergic bronchopulmonary aspergillosis (allergic bronchopulmonary aspergillosis ABPA) is often characterized by recurrent asthma, accompanied by cough, sputum, and mucopurulent sputum, sometimes with bloodshot eyes, which can separate brown phlegm thrombi. There is low-grade fever, wheezing or rales can be heard in the lungs, X-ray examination shows infiltrating shadows, segmental atelectasis, toothpaste sign or finger sleeve sign (bronchial mucus embolism), and peripheral blood eosinophils are significantly increased. Aspergillus allergen skin pricks can cause biphasic skin reactions (immediate and delayed), and serum IgE levels are usually more than 2 times higher than normal.

7. Gastroesophageal reflux (GER) Postnasal drip syndrome (PNDS) In diseases such as esophageal achalasia and cardia spasm, the contents of the stomach or duodenum often flow back into the esophagus through the lower esophageal sphincter. Most fluids are acidic. As long as a small amount is inhaled into the trachea, the upper airway receptors can be stimulated to reflexively cause bronchospasm through the vagus nerve, resulting in coughing and wheezing. It has been reported that the incidence of GER in patients with severe asthma can be close to 50%, indicating that GER At least it is an important inducement that makes asthma patients continue to attack and their symptoms are difficult to control. Targeted treatment of GER can significantly improve asthma symptoms.

Postnasal drip syndrome (PNDS) is common in chronic sinusitis, and its secretions often enter the trachea through the posterior nasal passage when the patient is lying down. It can cause cough and wheezing symptoms similar to asthma. It is also part of asthma patients who have repeated attacks and An important factor in poor efficacy.


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