Clinical features

• a history of asthma ^b
• severity of asthma 
  • normal peak expiratory flow rate ^d and whether it feels worse than normal ^c
  • any life-threatening asthma attacks (e.g. respiratory attacks or intubations)
  • number of emergency department visits in the last 6 months ^a
  • any hospital admission within 12 months ^b
  • recent discharge from hospital ^a  

• recent symptoms
  • wheezing ^b  
  • cough ^b   
  • any dyspnoea
  • exertional dyspnoea
  • difficulty performing work or other activities due to physical health within last 4 weeks ^a  
• current medication and its use ^b  
• triggers for attacks ^d
• any psychosocial problems ^b  

• signs of severity ^b
  • moderate-severe dyspnoea
  • pulse 120 beats or more per minute
  • respiratory rate 30 or more per minute
• evidence of airway obstruction ^b  
  • wheezing
  • barrel chest
  • hyperresonance
  • forced expiratory time ^b

Note: pulsus paradoxus is not very helpful at diagnosing airflow limiation   ^b

• evidence of hypercapnia: ^c  
  • this is more likely with
    • a quiet chest
    • too dyspnoeic to talk
    • cyanosis
    • requiring supplemental oxygen
    and less likely with
    • on beta-agonists
    • use of accessory muscles
    • no previous visit to emergency department within 2 weeks
• psychiatric symptoms or denial ^c