title: Ground zero: not asthma at all.
abstract: Upper airway obstruction is commonly misdiagnosed as asthma. We report on four children with recurrent respiratory symptoms who had been erroneously diagnosed as having asthma and who received anti-asthma medication for several years. The evaluation of spirometry tracing was neglected in all cases. Subglottic stenosis, tracheomalacia secondary to tracheo-esophageal fistula, double aortic arch, and vocal cord dysfunction were suspected by direct inspection of the flow-volume curves and eventually diagnosed. The value of clinical history and careful evaluation of spirometry tracing in children with persistent respiratory symptoms is critically discussed.
authors.affiliation: Department of Mother and Child Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy.
authors.forename: Fernando Maria
authors.initials: FM
authors.lastname: de Benedictis
authors.affiliation: Department of Mother and Child Health, Azienda Ospedaliera, Perugia, Italy.
authors.forename: Diletta
authors.initials: D
authors.lastname: de Benedictis
authors.affiliation: Department of Paediatric Anesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mirabile
authors.affiliation: Department of Cardiovascular Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pozzi
authors.affiliation: Family Paediatrician, Ancona, Italy.
authors.forename: Arcangela
authors.initials: A
authors.lastname: Guerrieri
authors.affiliation: Department of Paediatrics, University of Chieti, Chieti, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Di Pillo
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D001999:Bronchoscopy; D002648:Child; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D013147:Spirometry; D016896:Treatment Outcome; D019564:Unnecessary Procedures
chemical_list: D018927:Anti-Asthmatic Agents
keywords: asthma; children; flow-volume curves; spirometry