Patterns of asthma

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Asthma attack may progressively worsen over days, with more frequent, severe, and long-lasting episodes of bronchial obstruction, often associated with thick and viscid expectorations. A striking feature among clinical signs of severity is exhaustion.

In contrast, the attack may supervene suddenly in an apparently previously symptomless patient and develop in a fulminant way leading to severe respiratory failure in minutes or a few hours. This has been called sudden asphyxic asthma. Most of these patients are in coma, with a high incidence of respiratory arrest and cardiovascular instability. They develop marked mixed acidosis or extreme hypercapnia (with PaCO2 reaching values above 200 mmHg (26.7 kPa)). Response to therapy is usually very rapid, with fast normalization of PaCO2 and pulmonary function tests. In view of the scanty expectorations and rapid time course, which contrasts with other asthmatics experiencing slow-onset attack, bronchospasm may be the preponderant pathogenic mechanism in these patients.

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