Di Marco Fabiano, Sferrazza Papa Giuseppe Francesco, Radovanovic Dejan, Santus Pierachille
Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy.
Dipartimento Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
Clin Mol Allergy. 2017 Feb 8;15:3. doi: 10.1186/s12948-017-0060-9. eCollection 2017.
Bronchial asthma is a heterogeneous respiratory condition which can be mimicked by a wide range of pathologies including upper airways stenosis. The accurate diagnosis of asthma, as with other conditions, may be influenced by fixation errors, which are common in medicine and occur when a physician concentrates on only one element of a clinical case without considering other relevant aspects. Here we report a challenging case characterized by the contemporaneous presence of a common disease, asthma, together with a rare respiratory disease, idiopathic tracheal stenosis.
The 56-year-old female patient, a former smoker, was referred to our outpatient clinic for exertional dyspnea and persistent wheezing. There were no other respiratory or systemic symptoms over the past three months, and a psychological component was suspected. Spirometry with flow-volume evaluation and bronchoscopy were the key elements to establish the diagnoses and provide treatments. Once the diagnosis of asthma was confirmed, the combination of the anti-inflammatory corticosteroid fluticasone and the rapid-acting bronchodilator formoterol in a single inhaler effectively controlled the patient's symptoms, confirming the favorable efficacy and safety profile which are reflected in the recommendations of the international guidelines.
In this paper we describe the clinical investigations and interventions that eventually confirmed a diagnosis of asthma complicated by an idiopathic tracheal stenosis and led to effective treatment of the patient. Awareness of fixation error may avoid misdiagnosis in patients with respiratory disease and a complicated history at presentation.
支气管哮喘是一种异质性呼吸系统疾病，可被包括上气道狭窄在内的多种病理状况所模仿。与其他疾病一样，哮喘的准确诊断可能会受到固定性错误的影响，这种错误在医学中很常见，当医生只专注于临床病例的一个要素而不考虑其他相关方面时就会发生。在此，我们报告一例具有挑战性的病例，其特征为同时存在一种常见疾病——哮喘，以及一种罕见的呼吸系统疾病——特发性气管狭窄。
这位56岁的女性患者既往有吸烟史，因劳力性呼吸困难和持续性喘息前来我院门诊就诊。在过去三个月里没有其他呼吸系统或全身症状，怀疑存在心理因素。肺功能检查结合流量-容积评估和支气管镜检查是确诊和提供治疗的关键要素。一旦确诊为哮喘，将抗炎皮质类固醇氟替卡松和速效支气管扩张剂福莫特罗联合制成单一吸入器，有效控制了患者的症状，证实了国际指南推荐中所体现的良好疗效和安全性。
在本文中，我们描述了最终确诊为合并特发性气管狭窄的哮喘并对患者进行有效治疗的临床检查和干预措施。意识到固定性错误可避免对有呼吸系统疾病且就诊时有复杂病史的患者误诊。
