Bronchial asthma

1. Usually long duration of recurrent episodes of cough, wheeze and breathlessness 2. History to suggest hyperirritable airways present ". #cute breathlessness is often precipitated by respiratory infection, e posure to cold, dust, pollen, emotional upset, or e ertion /. 0ast history of bronchial asthma 1. 2lood pressure3 Usually normal &but reactive hypertension can %$cur. $an be differentiated by absence of end organ damage and return to normal 20 when asthma is controlled, 4. Usually tachycardia only. No arrhythmia

Pulmonary oedema (cardiac asthma)

1. Relatively short duration, recurrent episodes are not as common as in asthma 2. No such history e cept when both diseases co! e ist ". $an be precipitated by emotional upset or e ertion. %ften preceding chest pain &'H(!)*+, and palpitation present &e.g. 'H(!)*+ and -. with pulmonary oedema, /. 0ast history of angina, infarction, hypertension, rheumatic heart disease, other cardiac problems 1. High 20 or hypotension favours diagnosis of pulmonary oedema

4. #rrhythmias li5e #+, ventricular ectopics, complete heart bloc5, and ventricular tachycardia favours pulmonary oedema 6. 8levated 7*0 if present favours diagnosis 9. $ardiomegaly, presence of ." or murmurs and muffled heart sounds favour pulmonary oedema :. $repitation more than rhonchi. $repitations more at the base &Ronchi alone can occur sometimes in early pulmonary oedema, 1;. 8$< ! 8vidence of 'H(, )*H or left atrial enlargement favour cardiac asthma

6. Normal 7*0 9. No cardiomegaly, heart sounds normal. .ometimes difficult to ma5e out heart .ounds due to the rhonchi :. Rhonchi only or Rhonchi more than crepitations. Rhonchi are uniformly heard all over the chest 1;. . 8$< ! Normal, unless there is coe isting 'H(

Note3 'n patients with acute breathlessness, when there is difficulty in differentiating between bronchial asthma and acute pulmonary oedema ''' when both co!e ist the following guidelines will help. =his problem is vory common in elderly individuals with acute breathlessness. )ate onset asthma is common in the elderly and lac5s typical features li5e atopic tendency <'*8 drugs useful in both, e.g.3 #minophyllin and % ygen Use drugs, which are indicated in one condition but not contraindicated in the other li5e ! isosorbide dinitrate, frusemide, steroid, digo in and de trose when indicated #*%'( drugs contraindicated in pulmonary oedema and 2ronchial asthma &e.g.3 avoid #drenaline, .albutamol, =erbutaline, and Normal saline which are contraindicated in pulmonary oedema and -orphine which is contraindicated in asthma,

.avoid