What might indicate a severe level of asthma in a patient?

The absence of wheezing can indeed indicate a severe level of asthma in a patient. While wheezing is commonly associated with asthma and represents narrowed air passages due to inflammation and bronchoconstriction, its absence in the context of asthma could signify a significant reduction in airflow. This can occur in severe asthma exacerbations when the airflow is so limited that wheezing may not be present, which is often a concerning sign. It suggests that the condition could be worsening, potentially leading to respiratory failure if not addressed.

In contrast, increased coughing may not necessarily indicate severity, as coughing can occur in various stages of asthma. Similarly, rare instances of shortness of breath might point to controlled or mild asthma rather than severe. Normal lung sounds upon auscultation also typically suggest a lack of significant airway obstruction or distress, which would be contrary to what is usually expected in a severe asthma case.