title: Clinical Mimics: An Emergency Medicine-Focused Review of Asthma Mimics.
abstract: BACKGROUND
  Asthma is a common diagnosis or preexisting condition, and many patients with acute asthma exacerbation may present to the emergency department with wheezing and respiratory distress. However, many conditions may mimic this presentation.
  
  
  OBJECTIVE
  This review provides an overview of common asthma mimics and an approach to evaluation and management.
  
  
  CONCLUSIONS
  Asthma is characterized by an obstructive pulmonary disease with recurrent exacerbations. The disease may present with a variety of symptoms, including wheezing, chest tightness, shortness of breath, and even respiratory failure. Mimics include anaphylaxis, angioedema, central airway obstruction, heart failure, allergic reaction, foreign body aspiration, pulmonary embolism, and vocal cord dysfunction. The approach to evaluation and management of these patients includes assessment for life-threatening conditions while treatment and resuscitation is underway. Providers should assess for red flags, including no history of asthma, lack of severe asthma, and no improvement with standard treatments. Focused assessment with history, physical examination, chest imaging, electrocardiogram, and laboratory studies may provide benefit. Through consideration of these mimics and treatment, providers can provide rapid management.
  
  
  CONCLUSIONS
  While asthma is a common disease, many asthma mimics exist. Through consideration of other diseases with wheezing and assessing for red flags, such as patients presenting without a history of asthma or patients with a history of only mild asthma presenting with severe symptoms, emergency providers may decrease the chance of early diagnostic closure and anchoring while improving the care of these patients.
authors.affiliation: Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas.
authors.forename: Kristen
authors.initials: K
authors.lastname: Kann
authors.affiliation: Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas.
authors.forename: Brit
authors.initials: B
authors.lastname: Long
authors.affiliation: Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Alex
authors.initials: A
authors.lastname: Koyfman
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis; D000707:Anaphylaxis / Q000175:diagnosis; D000799:Angioedema / Q000175:diagnosis; D001249:Asthma / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis; D011859:Radiography / Q000379:methods; D012135:Respiratory Sounds / Q000209:etiology
keywords: asthma; mimic; respiratory distress; respiratory failure; stridor; wheeze