29-year-old girl does not cough nor breathe, only has a seizure of chest tightness, often thoughtless, depressed, easy to wake up at night, the original cheerful and lively personality gradually depressed, many times to the local hospital for treatment did not know the cause, come to our hospital for lung function examination, actually bronchial asthma!
A 10-year history of allergic rhinitis and a family history of bronchial asthma alert doctors
29-year-old Xiao Zhang recurrent chest tightness for 2 years, in order to find out the cause, she has done many electrocardiograms, Holter electrocardiograms, skull, chest CT, color ultrasound and other examinations, repeated blood tests, but no obvious abnormalities were found, and the cause was not clear in many hospitals, and the mood was depressed.
The patient followed the advice of the experts and went to the Department of Respiratory and Critical Care Medicine to find Dr. Zhao Guihua, and during the consultation, the doctor learned that the patient had a 10-year history of allergic rhinitis and a family history of bronchial asthma, so it was highly suspected that she had atypical bronchial asthma. But what I didn't expect was that Xiao Zhang's basic lung function was not abnormal, and at this point, many doctors may consider that the patient's chest tightness has nothing to do with the lungs, and further consider improving the examination of other parts.
Dr. Zhao Guihua thought according to past experience that it is not so simple, it is recommended to further improve the examination of airway reactions, and sure enough, Xiao Zhang appeared obvious chest tightness symptoms after doing bronchial stimulation tests, lung function for one second, peak flow rate were significantly reduced, the result was positive, and after further use of bronchodilators, Small Zhang chest tightness symptoms improved, and lung function also returned to the basic level. Combined with Xiao Zhang's symptoms and signs and auxiliary examination, it strongly suggests bronchial asthma, and the cause of Xiao Zhang's chest tightness has finally been found.
Why is bronchial asthma so easy to misdiagnose?
When it comes to bronchial asthma, many people think of the dangerous situations of "shortness of breath and lack of breath" in film and television dramas. In fact, these are typical manifestations of acute exacerbations of bronchial asthma, and these severe symptoms of recurrent asthma can indeed bring pain to patients and even endanger their lives.
Bronchial asthma is a chronic disease of the respiratory tract (according to the latest statistics: there are about 358 million people with asthma in the world, and about 45.7 million asthma patients in China over the age of 20, which seriously threatens people's physical and mental health). Some atypical bronchial asthma only mild chest tightness, chest pain, hyperventilation, children may have long sighs, hyperactivity, lack of concentration and other symptoms, very easy to misdiagnosis, missed diagnosis, and even long-term diagnosis can not be diagnosed, easy to develop into severe typical bronchial asthma.
Why doesn't coughing or wheezing also hide asthma?
According to experts, the diagnosis of typical bronchial asthma is relatively easy, but coughing and wheezing is not a necessary symptom of bronchial asthma, and there are many asthma patients like Xiao Zhang, who on the surface do not have symptoms of coughing and wheezing at all.
At present, the more common atypical bronchial asthma includes cough variant asthma and chest tightness variant asthma, of which the typical features of the latter do not have the typical symptoms of wheezing and dyspnea in patients with bronchial asthma, nor do they have recurrent coughs, but they have airway hyperresponsiveness and reversible airflow restriction, and Xiao Zhang's condition belongs to this category. For chest tightness, chest pain, long sighs, excessive ventilation, some children will have hyperactivity, inattention and other symptoms, it is easy to misdiagnosis, missed diagnosis. These symptoms are haunting, recurring, and even cause patients with depression, sensitivity, anxiety, insomnia and other mental and emotional conditions. It has seriously affected the work, life and study of patients, and some patients have repeatedly shuttled to respiratory, cardiology, neurology, traditional Chinese medicine and even psychiatry for medical treatment.
What are the characteristics of atypical bronchial asthma?
This type of asthma exhibits some characteristics similar to typical asthma, such as airway hypersensitivity and reversible airflow restriction. The clinical manifestations of atypical bronchial asthma are diverse, and patients are often misdiagnosed as bronchitis, pneumonia, upper respiratory tract infections, coronary heart disease, angina, neurosis and other diseases. There are generally no typical asthma manifestations such as recurrent wheezing and shortness of breath, and there is no wheezing sound on auscultation of the lungs, but it has highly sensitive airway response, reversible airflow restriction, and pathological features of typical asthma. At the onset of the disease, patients feel chest tightness, chest tightness, breath holding, etc., young and middle-aged people are more common, the onset is hidden, chest tightness can be induced after activity, and some patients have more frequent night attacks.
It is generally recommended that patients with chest tightness and cough, especially recurrent attacks, nocturnal onset, spontaneous remission, and those with a history of allergies or a family history of allergies, should consider atypical asthma and investigate, and if lung ventilation is normal or have small airway dysfunction, further pedestrian airway response measurement should be done. After being given medications to treat asthma, the patient's symptoms can be relieved or well controlled, reducing the chance of developing typical asthma and even long-term relief.
Allergic diseases are getting more and more frequent, and "small" allergic rhinitis should not be careless
In recent years, with the rise of allergic diseases, there are more and more patients with allergic rhinitis around them, especially in the season of high incidence of allergic diseases such as spring and autumn, outpatient patients are endless.
Many people think that allergic rhinitis is itching, tearing, sneezing, endure it, not serious and do not need treatment, but in fact, allergic rhinitis is closely related to asthma, clinically about 40% of allergic rhinitis patients will cause asthma. Although allergic rhinitis belongs to the upper airway inflammation, asthma belongs to the lower airway inflammation, but the two are often accompanied, theoretically both belong to "a respiratory tract of the same disease", if the patient has allergic rhinitis, while inducing asthma, must actively control the symptoms of allergic rhinitis, to avoid further asthma.
At present, for patients with early allergic rhinitis, it is recommended to actively give radical treatment, and there are three main treatment methods: removal of allergens; drug treatment, commonly used drugs are glucocorticoids, mainly topical drugs in the nasal cavity, as well as oral antihistamine drugs, commonly used with drugs such as loratadine; and then desensitization treatment. For patients with chronic allergic rhinitis, the recurrence of rhinitis should be actively controlled and avoided developing asthma.
Expert Profile Zhao Guihua
Deputy Director and Deputy Chief Physician of the Department of Cardiorespiratory Function of Henan Provincial People's Hospital, Member of the Pulmonary Function Group of the Respiratory Disease Branch of the Chinese Medical Association, Member of the Lung Function and Clinical Respiratory Physiology Working Committee of the Respiratory Physician Branch of the Chinese Medical Doctor Association, Member of the Chinese Lung Function Alliance, Deputy Leader of the Pulmonary Function Group of the Respiratory Disease Branch of the Henan Medical Doctor Association, Expert of the Writing Group of the Series of Guidelines for Lung Function Examination in Mainland China, And Participated in a number of scientific research projects related to clinical lung function.
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