The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Clinical Variants of Asthma

John Heffner, MD Tuesday, November 5, 1996

Asthma can produce a variety of symptoms in differing combinations. Consequently, individual patients may present with unique clinical manifestations that do not fit the general mold of "routine asthma," which is characterized as recurrent episodes of bronchospasm with shortness of breath. Asthma may present, for instance, as an isolated cough that occurs persistently, intermittently, or only after exercise. The latter form of asthma is termed "exercise-induced" bronchospasm. Asthma may also generate persistent shortness of breath without the usual episodes of exacerbations and remissions. Such patients may be misdiagnosed as emphysema or chronic bronchitis if they have a smoking history. New information is also emerging regarding the chronobiology of asthma. The degree of airway inflammation may vary during a 24-hour period with exacerbations developing 4-6 hours after patients fall asleep. In this setting, asthma may present more as a sleep deprivation syndrome. Additional variants of asthma include unique drug sensitivities (aspirin intolerance), nasal polyposis, sinus congestion, and mucoid impaction causing fleeting pulmonary infiltrates. All of these conditions require an astute physician to recognize the existence of underlying asthma and initiate appropriate therapy for these variant manifestations of a common disease.

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