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Allergy and Airway |

Poorly Controlled Persistent Wheezing: Is This Asthma?

Giselle Barraza*, MD; Claudia Fernandez, MD; Jon Roberts, MD; Mary Cataletto, MD
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Winthrop University Hospital, Mineola, NY


Chest. 2012;142(4_MeetingAbstracts):4A. doi:10.1378/chest.1388515
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Abstract

SESSION TYPE: Airway Cases I

PRESENTED ON: Monday, October 22, 2012 at 01:45 PM - 03:00 PM

INTRODUCTION: Anatomic airway anomalies should be considered in all children with persistent or recurrent wheezing which is unresponsive or poorly responsive to bronchodilators.

CASE PRESENTATION: Our patient has a history of chronic cough with wheezing since infancy with exacerbations triggered by both upper respiratory tract infections and exertion. Chart review showed recurrent episodes of wheezing on exam interspersed with normal chest exams. The working diagnosis was asthma. She came to our attention at age 12 years on a regimen of Serevent/Fluticasone 250/50, Montelukast and used Albuterol for rescue. On this regimen she still required multiple steroid bursts but because of variable compliance no further workup was done beyond an allergy evaluation which indicated seasonal nasal allergies. Chest radiographs were normal. Spirometry showed expiratory flow limitation and persistent flattening of the proximal portion of the flow-volume loop. During the subsequent 5 years her clinical course was essentially unchanged. At bronchoscopy the following images were taken: Image 1: complete tracheal rings; Image 2: tracheal bronchus Definitive Treatment: A slide tracheoplasty was performed. At five years post tracheoplasty follow up our patient is doing well with minimal exercise related symptoms.

DISCUSSION: Complete tracheal rings are rare and consist of absence of the posterior membranous portion of the trachea. Findings may be limited to a single segment of the trachea, multiple segments or may involve the entire trachea. Typical presentation occurs in the first year of life and is frequently associated with other malformations, particularly cardiac in origin. Symptoms may include dyspnea or stridor that is exacerbated with upper respiratory tract infections or physical exertion. Computerized tomography of the chest and bronchoscopy are used to define the extent of the lesion, identify other lesions and help to plan for definitive care. Tracheoplasty of stenotic segments is often helpful.

CONCLUSIONS: Our case is unusual because of the age at diagnosis,which more commonly occurs in the first few years of life.

1) Aneeshkumar MK., Ghosh S., Osman EZ., Complete tracheal rings: lower airway symptoms can delay diagnosis. Eur Arch Otorhinolaryngol. 2005 Feb: 264 (2): 161-162

2) Andrews TM, Cotton RT, Bailey WW, Myer CM 3rd, Vester SR, Tracheoplasty for congenital complete tracheal rings, Arch Otolaryngol Head Neck Surg. 1994 Dec; 120(12):1363-9

3) Gallagher TQ, Hartnick CJ., Slide tracheoplasty, Adv Otorhinolaryngol. 2012; 73: 58-62.

DISCLOSURE: The following authors have nothing to disclose: Giselle Barraza, Claudia Fernandez, Jon Roberts, Mary Cataletto

No Product/Research Disclosure Information

Winthrop University Hospital, Mineola, NY

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