title: Sinusitis and chronic progressive exercise-induced cough and dyspnea.
abstract: We present the case of a 47-year-old man with exercise-induced dyspnea, cough, chest tightness, and recalcitrant chronic rhinosinusitis. Evaluation revealed IgE sensitization to grass, tree, and weed pollen, no evidence of obstruction on spirometry, and a negative methacholine challenge. Diagnostic considerations included allergic and nonallergic rhinitis, asthma, aspirin-exacerbated respiratory disease, vocal cord dysfunction, extra-esophageal manifestations of acid reflux, and vasculitits. Further evaluation with sinus imaging, laryngoscopy, ambulatory pharyngeal pH testing, upper endoscopy, and bronchoscopy led to a diagnosis. Key issues surrounding the diagnostic and therapeutic approaches to this patient's condition are reviewed.
authors.affiliation: Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, CA 92131, USA. a.williams@bmctotalcare.com
authors.forename: Adam N
authors.initials: AN
authors.lastname: Williams
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Simon
authors.forename: Katharine M
authors.initials: KM
authors.lastname: Woessner
mesh_terms: D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D015444:Exercise; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*
chemical_list: D007073:Immunoglobulin E