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Features of a severe attack

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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.

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