Avoiding misdiagnosis in patients with dyspnea and wheezing: a case report illustrating the clinical implications of fixation error

Abstract

BackgroundBronchial asthma is a heterogeneous respiratory condition which can be mimicked by a wide range of pathologies including upper airways stenosis. The accurate diagnosis of asthma, as with other conditions, may be influenced by fixation errors, which are common in medicine and occur when a physician concentrates on only one element of a clinical case without considering other relevant aspects. Here we report a challenging case characterized by the contemporaneous presence of a common disease, asthma, together with a rare respiratory disease, idiopathic tracheal stenosis.Case presentationThe 56-year-old female patient, a former smoker, was referred to our outpatient clinic for exertional dyspnea and persistent wheezing. There were no other respiratory or systemic symptoms over the past three months, and a psychological component was suspected. Spirometry with flow-volume evaluation and bronchoscopy were the key elements to establish the diagnoses and provide treatments. Once the diagnosis of asthma was confirmed, the combination of the anti-inflammatory corticosteroid fluticasone and the rapid-acting bronchodilator formoterol in a single inhaler effectively controlled the patient’s symptoms, confirming the favorable efficacy and safety profile which are reflected in the recommendations of the international guidelines.ConclusionsIn this paper we describe the clinical investigations and interventions that eventually confirmed a diagnosis of asthma complicated by an idiopathic tracheal stenosis and led to effective treatment of the patient. Awareness of fixation error may avoid misdiagnosis in patients with respiratory disease and a complicated history at presentation.

Spirometry practice and the impact of a phase 1 training workshop among health workers in southern Nigeria: a cross-sectional study

“…Where the necessary competency for the use of spirometer is lacking, disease burden cannot be objectively quantified with resultant misdiagnosis and mismanagement of such respiratory diseases like asthma and COPD, as inappropriate interpretation of spirometric values would mean a different diagnosis and a different treatment pathway [ 17 ]. In other instances, patients with dyspnea and wheezing have been diagnosed with cardiac diseases leading to people in low-and middle-income countries (LMIC), spending scarce resources on investigations like 2-D Echo and diagnosis of asthma eventually confirmed after proper spirometry is done [ 18 ]. Other asthma mimics have also been correctly diagnosed by deploying spirometry [ 19 ].…”