Asthma Management Handbook

Performing a physical examination to investigate asthma-like symptoms in adults

Recommendations

Perform a physical examination, including chest auscultation and inspection of upper respiratory tract for signs of allergic rhinitis.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Do not rule out the possibility of asthma without doing spirometry, because physical examination may be normal when symptoms are absent and this does not exclude a diagnosis of asthma.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

More information

Significance of findings on physical examination

Wheeze suggests asthma but does not prove the diagnosis. Widespread wheeze on auscultation of the chest during symptoms increases the probability that the patient has asthma, but this may also occur in patients with COPD, viral or bacterial respiratory infection, tracheomalacia or inhaled foreign body. Obese people who do not have asthma may also report wheezing.1

High-pitched stridor is commonly mistaken for wheezing in people with upper airway dysfunction.2 However, careful auscultation will reveal that the sound is localised to the upper airway (not peripheral airway expiratory wheezing).2 

Crackles on chest auscultation indicate an alternate or concurrent diagnosis.

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References

  1. Aaron SD, Vandemheen KL, Boulet LP, et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ. 2008; 179: 1121-1131. Available from: http://www.cmaj.ca/content/179/11/1121.full
  2. Morris MJ, Christopher KL. Diagnostic criteria for the classification of vocal cord dysfunction. Chest. 2010; 138: 1213-23. Available from: http://journal.publications.chestnet.org/article.aspx?articleid=1045155