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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).



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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.