[Psychogenic pseudo-asthmatic syndrome]

The authors present a case of a 42-year-old patient treated for severe attacks of dyspnoea and wheezing of 12 years duration. She was hospitalized 8 times in medical or pneumonology wards and underwent treatment in a sanatorium 6 times. Since 5 years she has been periodically and recently permanently on oral glucocorticosteroids. Dyspnoea was accompanied by diffuse wheezing and prolongs expiration. It was also observed that her mode of respiration during an attack consisted in forced expiration at small air volumes in the lungs. Theatrical behaviour of the patient was striking. Bronchial challenge with acetylcholine and metacholine was negative. Bronchoscopy revealed profound intussusception of the membraneous part of the trachea and bronchi. Psychiatric diagnosis confirmed hysterical personality. The demonstrated case proves that the value of bronchial challenge is difficult to overestimate in diagnosing asthma. It concerns not only cases where symptoms are scanty but also patients with the so-called troublesome treatment-resistant asthma.