Position and diaphoresis in acute asthma

Area of Science:

• Pulmonology
• Emergency Medicine
• Critical Care

Background:

• Bedside assessments for acute asthma severity commonly utilize pulsus paradoxus, PCO2, sternocleidomastoid retraction, and flow rates.
• Patient positioning may influence the accuracy of these severity indicators.

Purpose of the Study:

• To investigate the impact of patient position on objective measures of acute asthma severity.

Main Methods:

• A study involving 49 adult patients admitted to the emergency center with acute asthma.
• Comparison of vital signs (pulse rate, respiratory rate, arterial pH, PO2), pulsus paradoxus, sternocleidomastoid retraction, and peak expiratory flow rate (PEFR) between upright and recumbent patients.
• Calculation of the Fischl index to assess the need for hospital admission.

Main Results:

• Upright patients exhibited significantly higher pulse rates, respiratory rates, and pulsus paradoxus.
• Upright patients had significantly lower arterial pH, PO2, and PEFR compared to recumbent patients.
• All upright patients displayed sternocleidomastoid retraction; PEFR was markedly lower in upright (73.3 L/min) versus recumbent patients (225 L/min).
• The Fischl index, indicating need for admission, was elevated in 70% of upright and 88% of diaphoretic patients, versus only 7% of recumbent patients.

Conclusions:

• Patient position significantly influences bedside assessment parameters in acute asthma.
• The upright position is associated with more severe asthma indicators and a higher likelihood of hospital admission.
• Recumbent positioning may be associated with less severe asthma presentations or improved status.