Which of the following are ominous signs of an asthma attack?

The presence of fatigue and absent breath sounds during an asthma attack can be particularly concerning and indicative of an ominous situation. This combination suggests that the patient may be experiencing severe bronchoconstriction leading to inadequate airflow, thereby causing a diminished ability to breathe effectively.

When a patient is fatigued and exhibits absent breath sounds, it may imply that the muscles responsible for respiration are fatigued as well, leading to potential respiratory failure. Absent or decreased breath sounds, especially in the context of asthma, can signify that airflow is so limited that the normal wheezing associated with bronchial constriction is no longer audible. This scenario often indicates that the patient is in a critical state and necessitates immediate medical intervention.

In contrast, while wheezing and coughing, increased heart rate, and chest tightness can signal an asthma attack, they are not as immediately alarming as the combination of fatigue and absent breath sounds. These symptoms, while indicative of an asthma exacerbation, do not inherently suggest the impending severity or potential respiratory compromise that absent breath sounds can signify.