Monday, September 26, 2005

Asthma?

This is a 20 y/o woman seen last week. She is previously healthy with no label of lung disease. For the past 3-4 weeks she has had a dry cough with occasional expiratory wheezing and episodic dyspnea on exertion. No fevers/chills/NS/sputum production. She has also recently been diagnosed with mild iron-def. anemia and has been started on iron.
No PMHx.
Meds: prn albuterol (seems to help), PPI and Iron sulfate. Up to date on immunizations including typhoid, hep A and hep B.
SHx: No TOB/ETOH/IVDA. College student. Last year she spent 6 weeks in Peru in the poor outskirts of Lima as a missionary. She had a brief episode (2 days) of diarrhea and no other problems. She returned a month ago from 6 weeks as a missionary in Hong Kong.
FHx: non-contributory.
ROS: only respiratory complaints noted above.
On exam, WN/WD, in NAD. VS normal. HEENT WNL. Chest with occasional rare expiratory wheezing but overall good aeration. Normal heart, abdomen, extremities. No rash.
Spiro revealed normal FVC with FEV1~75%. Normal TLC and DLCO with increase RV/TLC.
Normal CxR.
What is your DDx and what would you do next?

4 comments - CLICK HERE to read & add your own!:

Jennings said...

Well, since you are posting this case and it involves Peru, I will put strongyloides on the list. This is because of the gastroenteritis and now a dry cough (and wheezing). I would check stool for O&P, check the CBC for eosinophils. I would probablky get a CXR to rule out other surprises, but with this type of infection I realize it would be negative.
The other thing about the PFT's: was the flow volume loop ok? Just to make sure there is no upper airway abnormalities in terms of inspiratory-loop flattening.

Baleeiro said...

The FVL was OK: a little coving but PIF and PEF were OK.

Arenberg said...

Put me down for what Jennings said. Sputum eosinophila or peripheral eosinophilia have to be lurking here somewhere

Baleeiro said...

The American Lung Association has a session on asthma and its management and might be a good starting point: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=33276
If your son has frequent attacks he should be seen by a pulmonary specialist in you area.