The absence of dyspnoea, cough and wheezing: a reason for undiagnosed airflow obstruction?

The diagnosis of obstructive lung disease (OLD) may be overlooked because of the poor correlation between the intensity of symptoms and the severity of airway obstruction (AO). Undiagnosed airflow obstruction (UDAO) is associated with health impairment and mortality. Questions remain such as the reasons for its occurrence and the underlying diseases. In a pulmonologist's private practice, the objectives were to detect UDAO in the absence of dyspnoea, cough and wheezing, to improve its screening following other anamnestic data, and to separate UDAO patients into "silent asthma" (SA) or "persistent obstruction".

Patients were subjected to a verbal questionnaire for the detection of alternative indication for pulmonary function tests (PFTs), to a physical examination and, in the case of a severe smoking habit, to a chest X-ray. PFTs were performed whenever an OLD history or another lung disease was present and, in the absence of any dyspnoea, cough and wheezing, when other symptoms and conditions occurred (sputum, chest tightness, fatigue, rhinitis, snoring; active/passive smoking, recurrent lower respiratory tract infections, asthma in childhood or in family, atopy).

Of 3762 consecutive patients, 1389 patients with AO were identified. Among them, 147 UDAO patients were detected with no history of dyspnoea, cough and wheezing (3.9% and 10.6%, respectively). All these patients had other suggestive symptoms and AO risk factors which justified PFTs. They presented with mild (65%), moderate (21%) or even severe (16%) AO. SA patients normalized their spirometric values under treatment.

The absence of dyspnoea, cough and wheezing is a fairly frequent finding and a reason for UDAO. PFTs are warranted with any suggestive symptoms and AO risk factors. The favourable follow-up underlines the importance of screening for UDAO.