Asthma without a wheeze!

Yep, you read it right.
One can have asthma without a wheeze.

Isn't bronchoconstriction a necessity to be considered as asthma?
Yes, that is the definition of asthma. Then how can asthma with no wheeze exist?

The wheeze seizes to exist when there is too much bronchoconstriction as in the case of Acute Severe Asthma. Just like one cannot play a trumpet with a closed bell.

Acute severe asthma or status asthmaticus occurs in airways that have increased tendency to inflame when  exposed to certain triggers.

Such triggers include:
  1. Allergens
  2. Infections
  3. Drugs
  4. Exercise
  5. Hyperventilation
  6. Cold air
  7. Stress
Once the patient develops bronchoconstriction as a result of these triggers he (male predominant) may spontaneously feel better or worse. If the constriction increases in intensity, status asthmaticus develops. Most probable cause includes improper management of asthma.

Signs in such patients include:

  • Cannot speak more than one syllable
  • Dyspnea
  • Chest tightness
  • Wheeze +/-
  • Cough +/-
  • Cyanosis


  • Increased ventilation 
  • Hyperinflation
  • Decrease in spirometric values and PEF (I have a theory that one can simply ask the patients to blow balloons and know their spirometric values rather than using a spirometer. More about this in my next post)
  • Hypoxia and hypercapnia
  • Tachycardia
  • Pulsus paradoxus +/-



One may use the following to remember the treatment:

  1. Sally sells bread (pred) for 5 dollars and water (hydro) for 100 dollars.

    Neb Salbutamol 5 mg UDV stat
    Tab. Prednisone 0.5 mg/kg stat
    Inj. Hydrocortisone 100-200 mg stat
  2. If the money isn't enough she sells a broom for 5 dollars. 

    Neb Ipratropium bromide 0.5 mg UDV stat
  3. If she needs more money she sells magnet for 1 dollar and keeps selling water (hydro) every 6 hours.

    Inj. Magnesium sulfate 1-2g IV stat
    Inj. Hydrocortisone 100-200 mg stat
If you have trouble memorizing any particular topic in medicine, please do let me know by commenting below. I shall post an article to minimize your boredom in any possible way I can :)

Keep smiling and have a great day!

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