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Life-threatening asthma — DIPIMC MCQ

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HardMedical EmergenciesLife-threatening asthmaDIPIMCDipIMC

A 28-year-old known asthmatic is acutely breathless. On examination there is a silent chest, an oxygen saturation of 90% on air, obvious exhaustion with a feeble respiratory effort, and she can no longer complete sentences. Which feature most clearly indicates life-threatening asthma requiring the most urgent escalation?

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Correct answer: B — A silent chest on auscultation

A silent chest indicates airflow too poor to generate wheeze and is a recognised feature of life-threatening asthma, together with cyanosis, exhaustion, a feeble respiratory effort and hypoxia, demanding immediate senior and critical-care input. Audible wheeze and a moderately raised respiratory rate suggest acute severe rather than life-threatening disease. A peak flow of 60% indicates a moderate exacerbation. Pearl: a tiring patient with a quiet chest is more dangerous than a noisy, wheezy one.

Reference: BTS/SIGN Guideline (Asthma); JRCALC Clinical Guidelines