Tanaka Y, Muto H, Akiyama N, Arai Y, Miyamoto Y, Sano Y
Department of Allergy and Respiratory Disease, Doai Memorial Hospital, Tokyo, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 May;32(5):518-21.
A 55-year-old male presented with a chief complaint of exertional dyspnea. He had a daughter suffering with bronchial asthma. He had no pertinent past history. He visited the outpatient clinic of a nearby hospital for evaluation of exertional dyspnea, but routine examination results were normal. He was therefore followed up for only about two weeks without treatment. He was sent to our hospital for further analysis. Physical examination revealed clear lung fields but his respiratory rate was 34 per a minute, PaO2 72.9 mmHg and PaCO2 39.7 mmHg. Respiratory function tests, chest XP, chest CT and ECG findings were unremarkable. Pulmonary infarction was ruled out with a pulmonary perfusion scintigram. However, he was hyperreactive to the acetylcholine inhalation challenge test, the respiratory threshold being 625 micrograms/ml. A variant form of bronchial asthma was thus suspected and a bronchodilator was administered. The medication was very effective. After several weeks, his symptoms had clearly disappeared. Therefore, in a case complaining of exertional dyspnea only, bronchial asthma should be ruled out as a possible cause and the acetylcholine inhalation challenge test might be helpful in making the correct diagnosis. Bronchodilator administration should also be considered.
一名55岁男性以劳力性呼吸困难为主诉前来就诊。他有一个患支气管哮喘的女儿。他既往无相关病史。他前往附近医院的门诊评估劳力性呼吸困难，但常规检查结果正常。因此，他未经治疗仅随访了约两周。之后他被送往我院进一步检查。体格检查显示双肺野清晰，但呼吸频率为每分钟34次，动脉血氧分压（PaO2）为72.9 mmHg，动脉血二氧化碳分压（PaCO2）为39.7 mmHg。呼吸功能测试、胸部X光、胸部CT和心电图检查结果均无明显异常。肺灌注闪烁扫描排除了肺梗死。然而，他对乙酰胆碱吸入激发试验反应过度，呼吸阈值为625微克/毫升。因此怀疑为支气管哮喘的一种变异形式，并给予了支气管扩张剂。用药后效果非常显著。几周后，他的症状明显消失。因此，对于仅主诉劳力性呼吸困难的病例，应排除支气管哮喘作为可能病因，乙酰胆碱吸入激发试验可能有助于做出正确诊断，同时也应考虑给予支气管扩张剂治疗。
