1. Wheeze with a difference
Dr. Aditya Jindal

2. 15 years
Female
Presented with
Dry cough
Breathlessness x 4m
Wheeze
Rapid worsening of symptoms x 3 days

3. Diagnosed as bronchial asthma
Given inhaled bronchodilators and steroids
Poor response
Respiratory failure
Endotracheal intubation and mechanical ventilation
Extubated within 2 days
Dramatic improvement

4. Discharged on MDIs and oral steroids Persistent wheeze
Referred to Pulmonary Medicine
Admitted for further evaluation

5. Examination findings
Respiratory system : Stridor +
Other systems : Normal
Suspected diagnosis:
Post intubation tracheal stenosis

9. Histopathological examination
Inflammatory myofibroblastic tumour of the trachea

11. Asthma mimics Shared symptomatology between respiratory disorders
Leads to other diseases being misdiagnosed as asthma
High index of suspicion required, especially in
Atypical presentations
Poor response to treatment

12. General hallmarks of asthma
Some combination of wheezing, chest tightness, cough, and dyspnea
Symptoms are often worse in early morning
Identifiable triggers provoke symptoms
Evidence of airflow obstruction which is at least partially reversible
King CS, Moores LK. Respir Care 2008;53(5):568 –580

13. Asthma mimics COPD VCD Congestive cardiac failure Pulmonary embolism
Cystic fibrosis
Bronchiolitis obliterans
Hypersensitivity pneumonitis
GERD
Central airway obstruction
ABPA
Asthma mimics
Tropical pulmonary eosinophilia
Loffler’s syndrome
Idiopathic hypereosinophilic syndrome
Churg-Strauss syndrome
King CS, Moores LK. Respir Care 2008;53(5):568 –580

14. All that wheezes is not asthma All wheezes are not wheezes
Learning points
All that wheezes is not asthma
All wheezes are not wheezes
High index of suspicion required, especially in
Atypical presentations
Poor response to treatment