Asthma and Paroxysmal nocturnal dyspnoea

[MedBunny15]

How to clinically differentiate between asthma and Paroxysmal nocturnal dyspnoea?

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[jdh71]

How to clinically differentiate between asthma and Paroxysmal nocturnal dyspnoea?

Improved asthma controlled medication will make asthma better, not PND. You can make an assessment of how well asthma is controlled by how much prn albuterol is being used every day, and how many exacerbations requiring prednisone have been happened in that last 6-12 months. Take all of this within the context of the PFTs, because if PFTs look normal from a spirometry perspective, asthma is probably under fairly good control. Clues to a PND on PFTs could be a decrease in DLCO rather that the classic increase seen in asthma. Finally at the end of the day if you're really stumped get an echocardiogram.

 

[Hernandez]

On clinical exam, have them lay flat when you auscultate. on occasion you'll hear them wheeze when laying down but not when sitting up.

But when in doubt....blame the heart....

 

[jdh71]

But when in doubt....blame the heart....

Always the heart. Look for that HFPEF. Especially in old ladies.

 

[group_theory]

I've had numerous referrals from patients with ischemic cardiomyopathy with EF < 10% where they have ongoing dyspnea, and the reason for referral is "rule out asthma/COPD" .... ehh, good for business I guess.

 

[Hernandez]

I've had numerous referrals from patients with ischemic cardiomyopathy with EF < 10% where they have ongoing dyspnea, and the reason for referral is "rule out asthma/COPD" .... ehh, good for business I guess.

Dx: "Cardiac denial syndrome." I tell my cardiologists the the good lord gave us 4-5 times the lung capacity that we need to do normal day to day activities, so unless you expect them to low sports it is the heart causing issues.

 

[group_theory]

Dx: "Cardiac denial syndrome." I tell my cardiologists the the good lord gave us 4-5 times the lung capacity that we need to do normal day to day activities, so unless you expect them to low sports it is the heart causing issues.

Is that syndrome for the patient or the cardiologist?

(obviously some cardiologists or cardiology group are better than others .... after a while, you know who you would refer your parents to and who to avoid)

 

[jdh71]

Is that syndrome for the patient or the cardiologist?

(obviously some cardiologists or cardiology group are better than others .... after a while, you know who you would refer your parents to and who to avoid)

Exactly. You begin to realize who can only cath or stress test and their brains are checked at the door a long time ago.

 

[PinkLithe]

In poorly controlled asthma frequent night-time awakenings are usually secondary to cough rather than shortness of breath. In PND, patients classically complain of severe shortness of breath with sleeping/lying down. Usually they don't c/o a cough as their chief concern. PND is also not relieved with a rescue inhaler, whereas asthma typically is.