Pseudo-asthmaFawzeia Abo Ali

Faculty of Medicine Ain Shams University

Asthma is a heterogeneous disorder with multiple clinical

phenotypes. any process that increases airway resistance can cause similar symptoms and are often misdiagnosed as asthma.

A high index of suspicion for alternative diagnoses must be

maintained if:Symptoms are atypical fails to respond to therapy.

Pseudo-asthma : A disorder that mimics asthma but is not asthma.

◄Vocal cord dysfunction◄GERD◄COPD◄Foreign body ◄Exercise induced dyspnea◄Psychogenic dyspnea(HVS)◄Sarcoidosis◄Cystic fibrosis

Vocal Cord Dysfunction (VCD) Paroxysmal adduction of

the vocal cords, resulting in airway restriction.

Patients commonly report shortness of breath, wheezing, and cough, during exercise or stress.

Patients are often

misdiagnosed with asthma

diagnosis: larygoscopy

The spirometry flow-volume loop

treatment: speech therapy Psychotherapy.

inhaled anticholinergics.

control irritating factors such as gastroesophageal reflux and rhinitis with post-nasal drip.

COPD

Pseudo-asthma and gastroesophageal reflux

GERD #ASTHMA

Pseudo-asthma and GERD:

Foreign body aspiration

which should be suspected in any patient who presents with wheezing of sudden onset even in the absence of a clear history of a choking episode, and in any child with a unilateral wheeze or unequal breath sound.

There are occasions where in it might trigger a generalized irritant response causing diffuse polyphonic wheezes.

the following conditions, facilitate foreign body aspiration in adults:

Impaired swallow reflex Impaired cough reflex Alcohol or sedative use General anathesia Dental, pharyngeal procedures Loss of consciousness,Convulsions

Frequently aspirated objects include food (especially nuts and seeds), teeth, and dental appliances.

Hyperventilation Syndrome

Sarcoidosis:

CysticFibrosis is the second most common chronic inflammatory

airway disease, at least among the white population.

CFTR

Confusing points: some people do not present with respiratory

symptoms until adolescence or even adulthood.

Some degree of bronchodilator response may even be present.

Also, asthma can coexist with cystic fibrosis. Cystic fibrosis should be suspected when

symptoms and signs of airway inflammatory disease persist despite a short course of high-dose systemic corticosteroid.

Cardiac asthma "Cardiac asthma" is a term

commonly used to refer to wheezing associated with heart failure.

Patients who truly have cardiac asthma (ie, wheezing with acute heart failure, but without any other acute pulmonary pathology) generally respond well to a combination of bronchodilators, supplementary oxygen, and treatment of the heart failure itself .

Churge strauss diseaseEosinophilic granulomatosis with polyangiitis (EGPA)

WEINBERGER,ABU-HASAN ,PEDIATRICS Volume120 ,Number4, 2007

◄Exercise induced dyspnea

Is it true or pseudo- asthma or?

Asthma is more likely Asthma is less likely

More than one of these symptoms:•wheeze•breathlessness•chest tightness•coughrecurrent or seasonalHistory of allergiesSymptoms triggered by exercise, cold air, irritantsWidespread wheezeLower FEV1 or PEF Eosinophilia or raised blood IgE level,

Dizziness, light-headedness, Isolated coughChronic sputum productionclear chest when symptomaticChange in voiceHeavy smoker (now or in past)Cardiovascular diseaseNormal spirometry or PEF when symptomatic

References Pseudo-asthma: When Cough, Wheezing, and Dyspnea Are Not AsthmaMiles Weinberger, Mutasim Abu-HasanPediatrics Oct 2007, 120 (4) 855-864; DOI: 10.1542/peds.2007-0078 Vassilyadi M, Strawsburg RH. Delayed onset of vocal cord paralysis after

explantation of a vagus nerve stimulator in a child. Childs Nerv Syst. 2003;19:261–263

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Gilljam M, Ellis L, Corey M, Zielenski J, Durie P, Tullis DE. Clinical manifestations of cystic fibrosis among patients with diagnosis in adulthood. Chest. 2004;126:1215–1224

Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged nonspecific cough in children and adults. Cochrane Database Syst Rev. 2006;(4):CD004823

Baharloo F, Veyckemans F, Francis C, et al. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 1999; 115: 1357-1362. 40

Cardiac Asthma. Lancet 1990; 335: 693-694. Bethesda,MD. Physical Activity Issues and Concerns p. 88. NHLBI. Asthma and

Physical Activity in School:Making a difference. Abramsom, S. Allergen in school settings: Result of Environmental Assessment in a

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