Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 61-62
All that wheezes is not asthma


1 Department of Emergency Medicine, St. John's Medical College and Hospital, Tamaka, Kolar, Karnataka, India
2 Department of Otorhinolaryngology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India
3 Department of General Medicine, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India

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Date of Web Publication22-Jan-2013
 

How to cite this article:
Narayan G, Narayana G K, Prabhakar K. All that wheezes is not asthma. J Emerg Trauma Shock 2013;6:61-2

How to cite this URL:
Narayan G, Narayana G K, Prabhakar K. All that wheezes is not asthma. J Emerg Trauma Shock [serial online] 2013 [cited 2020 Sep 26];6:61-2. Available from: http://www.onlinejets.org/text.asp?2013/6/1/61/106331


Sir,

A 50-year-old female recently diagnosed with bronchial asthma presented with acute dyspnoea and wheeze. She did not respond to conventional treatment and progressed to acute respiratory failure requiring ventilation. The initial chest radiograph [Figure 1] was unremarkable. Two days later the patient developed left lung atelectasis [Figure 2], fiber optic bronchoscopy revealed a foreign body [Video 1], a betel nut in the left main bronchus. The betel nut [Figure 3] was removed and the patient was extubated five days later. The patient was a betel nut chewer and had aspirated it. Wheeze would have been heard due to a check-valve mechanism of airflow past the foreign body, and eventually a stop-valve mechanism, resulted in atelectasis [Figure 4].
Figure 1: Chest radiograph on day 1 immediately after intubation unremarkable

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Figure 2: Chest radiograph on day 3, patient on ventilator, showing left ling atelectasis

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Figure 3: Emergency bronchoscopy revealed a foreign body in left main bronchus

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Figure 4: Pathogenesis of wheeze heard would have been due to a bypass/check-valve mechanism of airflow past the foreign body initially, and eventually a stop-valve mechanism, resulting in atelectasis

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Airflow through a narrow airway generates a coarse whistling sound, which is known as wheeze and is often equated with asthma. Chevalier Jackson recognized "all that wheezes is not asthma" and described the above mentioned mechanism of bronchial obstruction by a foreign body. [1],[2] Another cause of wheeze that is at time misdiagnosed as asthma is pulmonary edema. Described as "cardiac asthma", wheeze is heard due to bronchial wall and intraluminal edema fluid cause narrowing of the small airways. [3] Other processes that narrow the diameter of an airway inducing wheezing include chronic obstructive pulmonary disease, endobronchial or endotracheal stenosis, buildup of airway secretions, endobronchial obstruction, upper airway obstruction, and allergic reactions. [4]

Establishing that wheezing is not due to asthma requires attention to the patient's history, physical examination results, and response to therapy.




 
   References Top

1.Braman SS, Davis SM. Wheezing in the elderly: Asthma and other causes. Geriatr Clin North Am 1986;2:269-83.  Back to cited text no. 1
[PUBMED]    
2.Ahmed T, Krieger BP, Wanner A. Differential diagnosis of asthma in the elderly. In: Barbee RA, Bloom JW, editors. Asthma in the elderly. New York: Marcel Dekker; 1997. p. 93-120.  Back to cited text no. 2
    
3.Osler W. Lectures on angina pectoris and allied states. New York: Appleton; 1897. p. 81.  Back to cited text no. 3
    
4.Krieger BP. When wheezing may not mean asthma. Postgrad Med 2002;112:101-11.  Back to cited text no. 4
[PUBMED]    

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Correspondence Address:
Girish Narayan
Department of Emergency Medicine, St. John's Medical College and Hospital, Tamaka, Kolar, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.106331

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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