Szmidt M, Instonajt B, Fijałkowski M
II Kliniki Gruźlicy i Chorób Płuc w Lodzi.
Pneumonol Alergol Pol. 1995;63(3-4):215-7.
The authors present a case of a 42-year-old patient treated for severe attacks of dyspnoea and wheezing of 12 years duration. She was hospitalized 8 times in medical or pneumonology wards and underwent treatment in a sanatorium 6 times. Since 5 years she has been periodically and recently permanently on oral glucocorticosteroids. Dyspnoea was accompanied by diffuse wheezing and prolongs expiration. It was also observed that her mode of respiration during an attack consisted in forced expiration at small air volumes in the lungs. Theatrical behaviour of the patient was striking. Bronchial challenge with acetylcholine and metacholine was negative. Bronchoscopy revealed profound intussusception of the membraneous part of the trachea and bronchi. Psychiatric diagnosis confirmed hysterical personality. The demonstrated case proves that the value of bronchial challenge is difficult to overestimate in diagnosing asthma. It concerns not only cases where symptoms are scanty but also patients with the so-called troublesome treatment-resistant asthma.
作者介绍了一例42岁患者，该患者因持续12年的严重呼吸困难和喘息发作接受治疗。她曾8次入住内科或肺病科病房，并6次在疗养院接受治疗。5年来，她一直定期且最近是长期服用口服糖皮质激素。呼吸困难伴有弥漫性哮鸣音和呼气延长。还观察到，她在发作期间的呼吸模式是在肺内小气量时进行用力呼气。患者的戏剧化行为很突出。乙酰胆碱和醋甲胆碱支气管激发试验为阴性。支气管镜检查显示气管和支气管膜部有严重套叠。精神科诊断证实为癔症性人格。所展示的病例证明，支气管激发试验在诊断哮喘中的价值难以高估。这不仅涉及症状较少的病例，也涉及所谓难治性哮喘的患者。
