Clinical Mimics: An Emergency Medicine–Focused Review of Asthma Mimics

Publication date: August 2017
Source:The Journal of Emergency Medicine, Volume 53, Issue 2
Author(s): Kristen Kann, Brit Long, Alex Koyfman
BackgroundAsthma is a common diagnosis or preexisting condition, and many patients with acute asthma exacerbation may present to the emergency department with wheezing and respiratory distress. However, many conditions may mimic this presentation.ObjectivesThis review provides an overview of common asthma mimics and an approach to evaluation and management.DiscussionAsthma is characterized by an obstructive pulmonary disease with recurrent exacerbations. The disease may present with a variety of symptoms, including wheezing, chest tightness, shortness of breath, and even respiratory failure. Mimics include anaphylaxis, angioedema, central airway obstruction, heart failure, allergic reaction, foreign body aspiration, pulmonary embolism, and vocal cord dysfunction. The approach to evaluation and management of these patients includes assessment for life-threatening conditions while treatment and resuscitation is underway. Providers should assess for red flags, including no history of asthma, lack of severe asthma, and no improvement with standard treatments. Focused assessment with history, physical examination, chest imaging, electrocardiogram, and laboratory studies may provide benefit. Through consideration of these mimics and treatment, providers can provide rapid management.ConclusionsWhile asthma is a common disease, many asthma mimics exist. Through consideration of other diseases with wheezing and assessing for red flags, such as patients presenting without a history of asthma or patients with a history of only mild asthma presenting with severe symptoms, emergency providers may decrease the chance of early diagnostic closure and anchoring while improving the care of these patients.



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