A 41-year-old male with cough, wheeze, and dyspnea poorly responsive to asthma therapy.
Reactive airway disease is often triggered by an upper respiratory viral infection and readily responds to anti-inflammatory and bronchodilator therapy. The differential diagnosis for unresponsive disease includes poorly controlled asthma, noncompliance with medical regimen, vocal cord dysfunction, rhinosinusitis, gastroesophageal reflux disease or recurrent aspiration, foreign body aspiration, allergic bronchopulmonary aspergillosis, Churg-Strauss vasculitis, cardiac disorders such as congestive heart failure or mitral stenosis, or other pulmonary disorders such as chronic obstructive pulmonary disease, alpha-1 antitrypsin deficiency, interstitial lung disease, bronchiectasis, sarcoidosis, hypersensitivity pneumonitis, pulmonary embolism, cystic fibrosis, airway neoplasms, or laryngotracheomalacia. As is often the case, a meticulous history can expeditiously direct the clinician to the diagnosis, especially in a patient without a smoking, asthmatic, or atopic history.
Ricketti
Peter A
PA
Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
Ricketti
Anthony J
AJ
Cleri
Dennis J
DJ
Seelagy
Marc
M
Unkle
David W
DW
Vernaleo
John R
JR
D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D001980:Bronchi / Q000276:immunology / Q000473:pathology* / Q000601:surgery*; D001999:Bronchoscopy; D003371:Cough; D003937:Diagnosis, Differential; D004351:Drug Resistance; D004417:Dyspnea; D006469:Hemoptysis; D006801:Humans; D007249:Inflammation; D008297:Male; D053120:Respiratory Aspiration / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D012135:Respiratory Sounds
D018927:Anti-Asthmatic Agents