L.B. says that the cough is worse at night and is associated with shortness of breath. The cough began approximately 6 weeks ago after she recovered from bronchitis
She runs 3 miles four times a week and reports occasionally experiencing a "coughing spell" after running. She has hay fever that seems to be
year-round and has eczema in the winter. Both of her children and her maternal grandmother have
asthma. She does not smoke and is not taking any medication other than a multivitamin.
What would you include in your physical examination, and why?
VS: Respiratory effort, respiratory rate, and oximetry to evaluate respiratory function.
Ear, nose, and throat (ENT): Because of the correlation between asthma and allergic rhinitis, observe
for findings associated with allergic rhinitis including pale, boggy turbinates, serous otitis, and
mucous drainage in the posterior pharynx.
Lung sounds: Often wheezing is heard, but breath sounds may be clear. If the patient's airways are
very constricted, treatment with a beta agonist may relax the airways enough for wheezing to
be heard. Patients with chronic obstructive pulmonary disease (COPD) often have distant breath
sounds; patients with pneumonia may have crackles, wheezes, and egophony.
Lymph node palpation: To determine if an infection of the upper respiratory tract may be responsible
for her symptoms.
Abdominal palpation: Look for gastric tenderness that often accompanies gastroesophageal reflux
disease (GERD), which is a frequent asthma trigger.
Skin: Eczema can be an atopic manifestation of asthma.
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