Tuesday, 26 November 2013

Asthma (Respiratory Disease) – Misdiagnosis

Respiratory Disease is defined as medical conditions which affect the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and  muscles breathing , etc,. I. Asthma
Asthma is a chronic inflammatory disease affecting the air way of the lung with recurring symptoms, such as wheezing, chest tightness, shortness of breath, and coughing. The disease affects people of all ages, and mostly starts during childhood. In the study of 463,801 children aged 13-14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304,796 children, found that for asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia(1). In the United States, approximately, asthma affects 25 million people, 7 million of them are children.
According to the study by Scripps Memorial Hospital, two common reasons asthmatics fail standard therapy are incorrect diagnosis and failure to recognize underlying contributing factors(41), including
1.  Vocal cord dysfunction
Vocal cord dysfunction (VCD) is a respiratory disorder characterized by paradoxical closure of the vocal cords during the respiratory cycle leading to obstructive airway symptoms. Misdiagnosis of VCD as asthma leads to inappropriate use of systemic steroids with its adverse effects, frequent emergency department visits, hospitalization, and, rarely, intubation and tracheostomy(42).

2. Respiratory bronchiolitis interstitial lung disease
Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is a type of idiopathic interstitial pneumonia (IIP) found to be associated with smokers. Many patients with interstitial lung disease have their chronic cough mistakenly attributed to that condition when, in fact, the cough is due to more common disorders such as asthma, upper airway cough syndrome (previously referred to as postnasal drip syndrome), or gastroesophageal reflux disease(43).

3. Chronic obstructive pulmonary disease (COPD)
According to the study by National Jewish Medical and Research Center, despite the availability of consensus guideline diagnostic recommendations, diagnostic confusion between COPD and asthma appears common. Increased awareness of the differences between the two conditions is needed to promote optimal patient management and treatment(44).

4. Psychogenic cough
Psychogenic cough and its relationship to asthma and other asthma-like illnesses is complex since distinct maladies with similar features may coexist individually or in combination in any given patient. While chronic cough may occur as a sole presenting manifestation of bronchial asthma in all age groups, recent findings suggest that most children with persistent cough without other respiratory symptoms do not have asthma, according to the study by Ohio University(45).

5. Tracheobronchomalacia
There is a report of 62-year-old woman, diagnosed as bronchial asthma 3 years previously, was admitted due to acute severe dyspnea. Physical examination revealed saddle nose, flare/swelling of the ear auricles, and stridor. Computed tomography demonstrated thickening of tracheal/bronchial walls and stenosis of the lumen that deteriorated on expiration, suggesting tracheobronchomalacia(46).

6. Tracheal schwannoma
There is a report of a case of  tracheal schwannoma in a female patient who presented with breathlessness and wheeze, and she was being treated for asthma(47).

7. Exercise-induced bronchoconstriction
A high proportion of English professional soccer players medicated for asthma/EIB (a third with reliever therapy only) do not present reversible airway obstruction or airway hyperresponsiveness to indirect stimuli, according to the study by University of Northumbria(48).

8. Etc.
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(1) http://www.ncbi.nlm.nih.gov/pubmed/9643741
(41) http://www.ncbi.nlm.nih.gov/pubmed/22128653
(42) http://www.ncbi.nlm.nih.gov/pubmed/11140406
(43) http://www.ncbi.nlm.nih.gov/pubmed/16093815
(44) http://www.ncbi.nlm.nih.gov/pubmed/16448970 
(45) http://www.ncbi.nlm.nih.gov/pubmed/17613629
(46) http://www.ncbi.nlm.nih.gov/pubmed/22790144
(47) http://www.ncbi.nlm.nih.gov/pubmed/22584990
(48) http://www.ncbi.nlm.nih.gov/pubmed/22175650

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