Löwhagen O, Ellbjär S, Jörgensen N, Toss L
allergidivisionen, Sahlgrenska sjukhuset, Göteborg.
Lakartidningen. 1996 Oct 16;93(42):3711-3.
A middle-aged man with variable breathing problems and frequent acute attacks, diagnosed as severe bronchial asthma, was given high-dose oral corticosteroid treatment. Owing to the somewhat atypical history, and normal lung function test results despite severe concomitant asthma-like symptoms, the diagnosis was reconsidered. As a new diagnostic work-up showed the presence of a disease of slight to moderate severity, it was decided to taper off the corticosteroid treatment. Within one year the daily dose of prednisolone was decreased from 40 to 7.5 mg without deterioration of the airway symptoms or impairment of lung function. Re-evaluation also showed the principal diagnosis not to be bronchial asthma but an asthma-like condition (functional breathing disorder combined with sensory hyperresponsiveness), and alternative not previously considered and a condition in which steroids are without apparent effect. This case illustrates the importance of a critical re-view of the diagnosis before high-dose corticosteroid treatment with its inevitable side effects is instituted.
一名中年男性，有多种呼吸问题且频繁急性发作，被诊断为重度支气管哮喘，接受了高剂量口服糖皮质激素治疗。由于病史有些不典型，尽管伴有严重的类似哮喘症状，但肺功能测试结果正常，因此重新考虑了诊断。一项新的诊断检查显示存在轻度至中度严重程度的疾病，于是决定逐渐减少糖皮质激素治疗。在一年内，泼尼松龙的每日剂量从40毫克降至7.5毫克，气道症状未恶化，肺功能也未受损。重新评估还显示，主要诊断并非支气管哮喘，而是一种类似哮喘的病症（功能性呼吸障碍合并感觉高反应性），是一种之前未考虑到的、使用类固醇无明显效果的病症。该病例说明了在开始使用高剂量糖皮质激素治疗及其不可避免的副作用之前，对诊断进行严格重新审视的重要性。
