Munchausen's syndrome. A case presenting as asthma requiring ventilation

We present a variant of Munchausen's syndrome not previously described in which acute severe asthma is the presenting complaint. The clinical presentation is so extreme that the patient has received artificial ventilation on several occasions despite having had normal arterial blood gas values. The patient appears to be able to mimic the signs of severe respiratory distress by means of a protracted Valsalva manoeuvre, and all signs of acute asthma instantaneously disappear with sedation. Because of the chronic 'asthma', and the frequent dramatic acute episodes, the patient successfully claims invalidity benefit, and has done so for many years.