Tos Y Disnea No Siempre Es Asma

Cough and dyspnoea is not always bronchial asthma
Case history
A 39-yr-old female patient who never smoked suffered from chronic dry cough and progressive exercise-induced dyspnoea over a periodof 18 months. In 2007, lung volumes were normal, but there was moderate bronchial hyperreactivity as assessed by bronchoprovocation with methacholine. There was a drop in forced expiratory volume in 1s (FEV1) of 22% predicted following administration of 0.2 mg methacholine. A diagnosis of asthma was made and the patient was treated with inhaled budesonide combined with formoterol. 1 yr later thepatient suffered from an exacerbation of symptoms and was prescribed oral corticosteroids for 2 weeks. A chest radiograph did not show any pathological abnormalities. There was no recovery and thepatient was admitted to our outpatient clinic. Physical examination revealed inspiratory rhonchi on the right side.
10 Flow/volume expired
Normal

L. Junker1 S. Lamm2 M. Tamm1 D. Lardinois2Clinics of 1Pulmonary Medicine and Respiratory Cell Research and 2 Thoracic Surgery, University Hospital Basel, Basel, Switzerland Correspondence L. Junker Clinic of Pulmonary Medicine and RespiratoryCell Research University Hospital of Basel Petersgraben 4 4031 Basel Switzerland junkerl@uhbs.ch

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Figure 1 Flow–volume loop, pre- and post-bronchodilator.

Task 1 Interpret the pulmonary function test on the basis of the flow–volume loop (figure 1).

ProvenanceSubmitted article, peer reviewed.

Competing interests None declared.

HERMES syllabus link: module B.2.5

DOI: 10.1183/18106838.0604.361

Breathe  June 2010  Volume 6  No 4

361

Cough anddyspnoea

The pulmonary function test shows a moderate obstructive ventilatory defect with a forced vital capacity of 3.43 L (102% pred) and FEV1 of 1.97 L (69% pred) without improvement following...