Baron Munchhausen's lung function expertise

A young anorectic woman suffering from asthma since her early childhood exacerbated without obvious cause and did not respond to treatment. Body plethysmography showed an isolated huge increase of the expiratory resistance. During inspiration, resistance was not elevated. However, in 1 out of 3 successive manoeuvres, expiratory resistance was completely normal. We believe this to be a Munchhausen's case coupled with a proven asthma. The pattern in lung function can be explained by putting the tongue forward into the spirometer's mouthpiece. In the assessment of asthma refractory to treatment, especially in workers in paramedical professions, Munchhausen's syndrome should be considered.