Asthma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]


The characteristic physical signs of asthma include: loud prolonged polyphonic expiratory wheeze and adventitious sounds such as rhonchi. Presence of wheeze is indicative of airway narrowing; however, the absence of wheeze indicates a silent lung characteristic of status asthmaticus delineated by widespread obstruction that results in significant airflow reduction and insufficient enough to produce a wheeze.[1]

Physical Examination

Physical examination may be normal or can be characteristically present with a loud polyphonic expiratory wheeze.[1][2]



  • Pulsus paradoxus (a fall of SBP between 10-20mmHg during inspiration) in moderately severe episode
  • Pulsus paradoxus (a fall of SBP greater than 20-40 mmHg during inspiration) in acute severe episode and imminent respiratory failure

Respiratory Rate

  • Increased respiratory rate greater than 30 cycles per minute in moderately severe and acute severe episodes


  • Profuse sweating in imminent respiratory failure
  • Severe hypoxia resulting in central cyanosis and hypoventilation in imminent respiratory failure


  • Conjunctival congestion as a consequence of constant rubbing are suggestive of associated allergic rhinitis.


  • Nasal examination is mandatory to rule out associated conditions such as, aspirin sensitivity or allergic rhinitis.
  • Transverse crease on nose as a consequence of constant rubbing and pale swollen nasal mucosa are suggestive of associated allergic rhinitis.


Mild Episode

  • Prolong end-expiratory wheeze
  • In between attacks, chest is clear and no abnormal physical signs may be detectable.

Moderately Severe Episode

  • Use of accessory muscles of respiration such as sternocleidomastoid and scalene muscles
  • Hyper-resonant lungs
  • Loud prolonged expiratory wheeze with a reduced inspiration to expiration ratio
  • Vesicular breath sounds with prolonged respiration

Acute Severe Episode

  • Patient has to sit upright with arms extended to support the upper chest (tripod position) that assist the use of accessory muscles of respiration
  • Use of accessory muscles of respiration

Imminent Respiratory Failure

  • Paradoxical thoraco-abdominal breathing
  • Wheeze and breath sounds are typically absent secondary to severe airway obstruction, representing a silent chest which is an ominous sign.

Chronic Asthma

Other Associated Findings


  1. 1.0 1.1 Korematsu S, Nagashima K, Sato Y, Nagao M, Hasegawa S, Nakamura H; et al. (2017). ""Spike" in acute asthma exacerbations during enterovirus D68 epidemic in Japan: A nation-wide survey". Allergol Int. doi:10.1016/j.alit.2017.04.003. PMID 28455155.
  2. Tan JHY, Chew WM, Lapperre TS, Tan GL, Loo CM, Koh MS (2017). "Role of bronchoprovocation tests in identifying exercise-induced bronchoconstriction in a non-athletic population: a pilot study". J Thorac Dis. 9 (3): 537–542. doi:10.21037/jtd.2017.02.70. PMC 5394074. PMID 28449460.

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