Kyphoscoliosis complicating asthma with fixed airway obstruction.

Introduction: Kyphoscoliosis is present in up to 2% of the juvenile population and can have deleterious effects on respiratory mechanics, leading to chronic respiratory failure later on in adult life. Case presentation: Hereby we describe a 53-year-old patient with severe uncontrolled asthma who presented with chronic hypercapnic respiratory failure. During her medical workup, she was noted to have several comorbidities leading to her respiratory failure. The patient had radiological evidence of bronchiectasis with recurrent episodes of infection, and a severe deformity of the spine due to Kyphoscoliosis. Probably the kyphotic component of this deformity had worsened due to a long history of oral steroid use leading to severe osteoporosis and consequent vertebral compression fractures reaching a Cobb angle of 73 degrees. This was probably caused by the patient's non-compliance with inhaler therapy and an excessive reliance on oral steroid use. Her respiratory failure was treated with domiciliary noninvasive positive pressure ventilation and 24-hour oxygen therapy and her symptoms improved. Conclusion: A multidisciplinary approach across different specialities is necessary when managing such a patient with kyphoscoliosis, bronchiectasis, asthma with airflow limitation with respiratory failure.

Tracheal hamartoma masquerading as asthma.

We present a rare case of a female non-smoker diagnosed with a large benign tracheal chondrohamartoma, masquerading as severe asthma. The patient was in her late 70s and had a history of asthma. She had presented to hospital with multiple episodes of intractable cough, shortness of breath and wheeze in the year prior to diagnosis. She had been managed for asthma for two decades by different physicians in primary care, based on documented airflow obstruction. Given her repeated admissions, the respiratory team was consulted. In view of the persistent cough despite maximal treatment, she was referred for a thoracic high-resolution CT scan which revealed a large intraluminal tracheal polypoid mass. Flexible bronchoscopy was performed and this confirmed the presence of a large pedunculated mass in the distal trachea. The patient subsequently underwent removal of the mass by means of rigid bronchoscopy, laser and electrocautery followed by argon ablation of residual tissue. She made an excellent recovery with full resolution of her respiratory symptoms and normalisation of her pulmonary function tests.