Central Airway Obstruction Masquerading as Difficult-to-Treat Asthma: A Retrospective Study

Large airway obstruction is well described as a cause of apparent asthma, unresponsive to the standard asthma therapy. Our purpose is to introduce multiple variants of other diseases that mimic asthma with failure to treat.

Between the years 2005 and 2008, clinical data from 16 patients with difficult-to-treat asthma (from 3200 patients who were evaluated in our ward for any reason) were reviewed at Massih Daneshvary Hospital.

Of the 16 patients, 5 were men and 11 women. Mean age was 40.43 years (40.43±SD=16.49). Dyspnea was present in 93.75% of the patients. Chest x-ray was normal in 62.5% of patients. Computerized tomography scan was normal in 18.75% of the patients. Endobronchial lesion was found in 87.5% of patients in which 50% was benign and 50% malignant. Vocal cord dysfunction was found in 6.25% of the patients whereas 6.25% had external pressure on tracheal lumen. Mean duration of asthma treatment was 23.8 months (range, 3 to 96 mo).

Asthma masqueraders include several conditions that may confound a correct diagnosis of asthma. A careful clinical examination, high index of suspicion, and appropriate analysis of spirometry are essential for the appropriate diagnosis and management of asthma. If there is no improvement after appropriate treatment, further evaluation should be performed.