features of a severe attack
Last reviewed 01/2018
In a severe attack the patient may be fearful and exhausted. Various clinical features are significant in assessing its severity:
- difficulty in speaking: the patient is so tachypnoeic and breathless that they have difficulty in forming phrases or sentences
- tachycardia - greater than 110 per minute; in a very severe attack the pulse becomes bradycardic
- pulsus paradoxus - this indicates severe airflow limitation
- silent chest - in a patient who is extremely breathless this implies that airflow restriction is severe enough to totally restrict airflow to parts of the lung
- drowsiness due to hypercapnia - this occurs only in a preterminal attack and is a very sinister sign
- cyanosis may also occur in the preterminal state
Investigations may reveal type II respiratory failure.