Major airway obstruction as a cause of chest wheezes

ABSTRACT

Asthma is a disorder characterized by narrowing of airways which is reversible with time either spontaneously or as a result of treatment. Asthma presents mainly with dyspnea wheezes and or cough which are mainly nocturnal. Many diseases can either mimic or worsen asthma. Patients are often subjected to full anti-asthma therapy without improvement. The aim of our study was to investigate the possible causes of chest wheezes rather than bronchospasm. Our study included 50 patients [25 in pediatric age group and 25 in adult age group]. They were all having longstanding wheezy chest with failure to respond to the usual anti-asthma medications. All the patients were subjected to thorough history taking with special emphasis on foreign body inhalation especially in the children's group; complete general as well as local examination; chest radiology; routine laboratory investigations and fiberoptic bronchoscopy. Our results showed that the commonest cause among all patients was laryngotracheomalacia present in 13 patients. The second most common cause was inhaled neglected foreign body in 9 cases, 8 children and one adult with history of foreign body inhalation at age of 10. The third common cause was malignant neoplasm in 6 adult cases. In conclusion when a patient presents with persistent or recurrent wheezing and the typical features of asthma are lacking, other causes for noisy breathing should be considered and one must be very careful in order not to miss another etiology. In childhood laryngotracheomalacia and foreign body inhalation are the commonest while in adults we should think in malignant obstruction. Fiberoptic bronchoscopy and laryngoscopy are essential tools for investigating these patients