La-Crette Jonathan, Abdelhamid Ahmed, Chadwick Andrew, Chakraborty Arup
Intensive Care Registrar, Milton Keynes University Hospital Trust.
ACCS Trainee, Milton Keynes University Hospital Trust.
JRSM Open. 2022 Mar 11;13(3):20542704221086165. doi: 10.1177/20542704221086165. eCollection 2022 Mar.
While Eosinophilic Asthma is frequently underdiagnosed, COPD is often misdiagnosed. This case focusses on a COPD misdiagnosis that had life-threatening consequences. The patient was a 59-year-old, male smoker, who presented to the Emergency Department with a week's history of increasing shortness of breath. On presentation, severe respiratory acidosis persisted acidotic despite Nebulisers, Oxygen, Steroids, and Magnesium. He was intubated for two weeks and had severe bronchospasm associated with type 2 respiratory failure. Eosinophils on admission were markedly elevated and remained so despite a week of intravenous steroids. As he missed the window for ECMO, we were advised to look at his diagnostic spirometry. Surprisingly, the spirometry done by his general practitioner, two years prior, showed Asthma not COPD. His blood eosinophils were elevated then, too. A revised diagnosis of Eosinophilic Asthma was given. Intravenous steroids were increased, and nebulised steroids were started. Soon thereafter, his condition improved, and he was stepped down from Intensive care. Hopefully, this case report increases physician knowledge of the different Asthma phenotypes and reduces incidences where correct treatment is only started during an avoidable life-threatening exacerbation.
虽然嗜酸性粒细胞性哮喘常常诊断不足，但慢性阻塞性肺疾病（COPD）却经常被误诊。本病例聚焦于一例导致危及生命后果的COPD误诊。患者为一名59岁男性吸烟者，因气短加重一周前往急诊科就诊。就诊时，尽管使用了雾化器、氧气、类固醇和镁剂，严重的呼吸性酸中毒仍持续存在。他插管两周，伴有严重支气管痉挛及Ⅱ型呼吸衰竭。入院时嗜酸性粒细胞显著升高，尽管静脉使用了一周类固醇药物，仍居高不下。由于他错过了接受体外膜肺氧合（ECMO）的时机，我们被建议查看他的诊断性肺功能检查结果。令人惊讶的是，他的全科医生两年前所做的肺功能检查显示为哮喘而非COPD。当时他的血液嗜酸性粒细胞也升高。于是给出了嗜酸性粒细胞性哮喘的修订诊断。增加了静脉类固醇药物用量，并开始使用雾化类固醇。此后不久，他的病情好转，从重症监护病房转出。希望本病例报告能增加医生对不同哮喘表型的认识，并减少仅在可避免的危及生命的病情加重时才开始正确治疗的发生率。
