Factitious asthma. Physiological approach to diagnosis

Area of Science:

• Pulmonology
• Psychiatry

Background:

• Recurrent emergency room visits and hospitalizations for bronchial asthma can be challenging to manage.
• Differentiating true asthma from conditions mimicking it is crucial for appropriate patient care.

Observation:

• Three patients presented with wheezing and respiratory distress, initially treated as bronchial asthma.
• Key diagnostic features of asthma, such as elevated alveolar-arterial oxygen tension difference, roentgenographic hyperinflation, and bronchial hyperreactivity, were notably absent.
• Patients exhibited self-induced wheezing localized to the neck, and two had a history of psychiatric illness.

Findings:

• The clinical presentation and diagnostic findings were inconsistent with the pathophysiology of bronchial asthma.
• The absence of objective asthma markers and presence of self-induced symptoms suggest an alternative diagnosis.
• A form of factitious illness, distinct from previously described syndromes, is proposed.

Implications:

• Recognition of this factitious illness syndrome can prevent unnecessary medical interventions and healthcare costs.
• Early identification allows for appropriate psychiatric assessment and management.
• This study highlights the importance of a comprehensive diagnostic approach in complex respiratory cases.