Print Email
 

Clinical Images

When Asthma is Not Asthma

Madeleine Strohl, BA, Clifford Packer, MD 

January 14, 2015

A 52-year-old woman with a five-pack-year smoking history was admitted to the hospital with persistent shortness of breath, wheezing and dry cough of two weeks’ duration following an upper respiratory infection. Her medical history was notable for a 72-hour intubation for hypoxic respiratory failure secondary to a drug overdose two months prior. She had never been hospitalized for shortness of breath in the past. She was prescribed an albuterol inhaler for seasonal allergies. She was now using her albuterol inhaler four times a day with minimal relief of her symptoms. During her admission to the hospital, she was given albuterol and ipratropium nebulizers and discharged to home to complete a five day course of prednisone for a presumed asthma exacerbation. 

She returned to the emergency department five days later when her symptoms persisted. Lung auscultation revealed mild bilateral expiratory wheezes and stridorous breath sounds on exertion. The rest of her physical exam was unremarkable. Her chest radiograph was normal. On spirometry, her flow-volume loop demonstrated marked limitation of the inspiratory and expiratory flow, consistent with fixed obstruction. Flexible laryngoscopy revealed 80% tracheal stenosis at the third tracheal ring. Computer tomography (CT) of the chest and neck with contrast confirmed the presence of a stenosis in the mid trachea with an area of 6mm by 3mm (Figure 1).

 

asthma



Click here to view the answer

References:

1. Zias N, Chroneou A, Tabba MK, et al. Post tracheostomy and post intubation tracheal stenosis: Report of 31 cases and review f the literature. BMC Pulm Med 2008;8:18.

2. Whited RE. Laryngeal dysfunction following prolonged intubation. Ann Otol Rhinol Laryngol 1979;88(4 Pt 1):474-478.

3. Poetker DM, Ettema SL, Blumin JH, Toohill RJ, Merati AL. Association of airway abnormalities and risk factors in 37 subglottic stenosis patients. Otolaryngol Head Neck Surg 2006, 135(3):434-437.

4. Nordin U. The trachea and cuff-induced tracheal injury. An experimental study on causative factors and prevention. Acta Otolaryngol Suppl 1977, 345:1-71.

 

 

About the authors:

 

Madeleine Strohl is a third year medical student at Case Western Reserve University School of Medicine in Cleveland, OH.

 

Clifford D. Packer, MD is associate professor of medicine at Case Western Reserve University School of Medicine, and attending physician at the Louis Stokes Cleveland VA Medical Center. 



 

Submit content to JGIM

JGIM encourages submission of articles aimed at improving patient care, education, and research in primary care and general internal medicine in all settings. Submissions must be original and not currently under consideration for publication in another peer- reviewed medium (paper or electronic).

Learn How to Submit Here

 

FEATURED ARTICLE

 

Darlyn Victor, MD, Paul Moots, MD and Jacqueline Fischer, MD

October 13, 2016

A 39-year-old African-A....

Read Article
 

Most Viewed Articles

73 Views

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study.

O’Brien, Matthew J.; Whitaker, Robert C.

Read Article| Download PDF
25 Views

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study.

O’Brien, Matthew J.; Whitaker, Robert C.

Read Article| Download PDF
31 Views

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study.

O’Brien, Matthew J.; Whitaker, Robert C.

Read Article| Download PDF

Most Recent Web Only Content

January

17

On the Penetrating Capacity of Ultrasound

Sarah Bugg

Read Article

December

20

Painful Eruption in a Mountain Biker

Jasna Ikanovic, MD and Animita Saha, MD

Read Article

November

19

Adverse Events In US Hospitals:1 in 3 Admissions Has At Least One Adverse Event

SGIM Evidence-Based Medicine Task Force

Read Article

August

25

Diagnostic Schema

Denise M. Connor, Rabih Geha, Mark Henderson, Jeff Kohlwes

Read Article