Pseudo-Asthma
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At 09:28 PM 8/29/97 -0400, John Fish, Jr. wrote:
>HELP!
>
>A friend of mine (20 yo Female), has had a pretty tough time with asthma
>for the past year or so.  I have had to transport her twice in the past two
>months and just the other day she was again transported by an RN/EMT-P.
>
>The Emergency Doctor at the local ED mentioned to the RN/EMT-P that he
>thinks the patient has "Pseudo Asthma". He gave no treatment in the ED
>(this time) and she did fine.
>
>The first time I transported her she went into respiratory arrest so I'm
>now getting a little concerned. Have any of you heard of pseudo asthma? If
>so is it possible for this pseudo asthma to get to the point of respiratory
>arrest?
>

I have certainly seen many patients comein complaining of dyspnea who's
primary problems were psychologic. They often make wheezing sounds which,
upon careful evaluation, come from the throat, not the lungs, and which
will often extinguish when told to do things like extend their necy, open
their mouths, speak, etc.

Whether you call this pseudo asthma, panic disorder, or whatever, it ain't
asthma.

I have been amazed to hear of such patients being intubated because they
"look so bad" clinically. In one case a few years ago, one such
"non-asthmatic" nearly died when he was given paralytics for intubation,
then the folks caring for him had trouble with the intubation. I've had
internists and even a pulmonologist send such patients to the ED because of
"life threatening bronchospasm." One internist in our system has a patient
whom she continues to insist has "non-wheezing varient asthma" in spite of
differing opinions from her partners, the pulmonologist, myself and a psych
consultant!

And, in my experience, these patients react very badly when told you don't
think its asthma.

Having said all this, be very careful. It is far better to treat someone
unnecessarily for asthma (short of intubation) than to withhold treatment
thinking "oh, this must be pseudo asthma..." I dare say that an EMT should
NEVER make an independent assessment of "pseudo asthma." Such a
determination should be made after careful evaluation in a controlled
setting, with full access to all available historical data, by a physician.

So, does your friend really have asthma? Alot of your story makes me
suspicious that she does not. But then you say she had "respiratory
arrest." Did she really stop breathing? For a prolonged period? Did she
have _documented_ hypoxia? elevated CO2? respiratory acidosis? Or was she
just intubated beause she "looked bad?" Has she ever had formal evaluation
by a pulmonologist? Full PFTs? Provocative testing?

I would be VERY careful about trying to make a diagnosis without these data.
***
Howard Blumstein, MD, FAAEM                   work phone 215-842-6072
Asst. Program Director
Allegheny University - MCP/HU (nee MCP)       Phila PA 19129