Sridaran Sankar, Gonzalez-Estrada Alexei, Aronica Mark A
Case Western Reserve University School of Medicine , Cleveland, OH 44195 , USA.
Department of Allergy and Clinical Immunology , Respiratory Institute, Cleveland Clinic Foundation , Cleveland, OH 44195 , USA.
Oxf Med Case Reports. 2014 May 8;2014(2):29-30. doi: 10.1093/omcr/omu012. eCollection 2014 May.
A 64-year-old female patient presented with a 16-year history of persistent dry cough that was undiagnosed after workups at several healthcare facilities. The patient denies wheezing, shortness of breath or sputum production. Previous workups include chest imaging, transthoracic echocardiogram (TTE), laryngoscopy, spirometry and bronchoscopy, all of which were unremarkable. During her current evaluation, spirometry was ordered again for the patient, which showed a post-bronchodilator improvement in the FEV1 by 13%, strongly suggestive of asthma. The patient was started on pharmacological therapy for severe persistent asthma, which led to sustained symptomatic improvement per evaluation at follow-up after 2 months. Spirometric findings, clinical presentation and resolution of symptoms with adequate therapy for asthma suggest that this is a case of cough variant asthma that went undiagnosed for several years. This case report summarizes the workup for chronic cough and how the diagnosis of cough variant asthma can be missed.
一名64岁女性患者有16年持续性干咳病史，在多家医疗机构检查后未确诊。患者否认喘息、气短或咳痰。既往检查包括胸部影像学、经胸超声心动图（TTE）、喉镜检查、肺功能测定和支气管镜检查，所有结果均无异常。在本次评估期间，再次为患者进行肺功能测定，结果显示支气管扩张剂使用后第一秒用力呼气容积（FEV1）改善了13%，强烈提示哮喘。患者开始接受重度持续性哮喘的药物治疗，2个月后的随访评估显示症状持续改善。肺功能测定结果、临床表现以及哮喘充分治疗后症状缓解表明，这是一例咳嗽变异性哮喘病例，多年来一直未被诊断。本病例报告总结了慢性咳嗽的检查过程以及咳嗽变异性哮喘如何会漏诊。
