Chronic upper airway obstruction

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Occult chronic upper airway obstruction is an unusual cause of the symptom complex of wheezing dyspnea. If unrecognized, appropriate therapy will be delayed and the results may be disastrous. The medical history, physical examination, chest roentgenogram, and results of pulmonary function testing can provide clues that enable the clinician to suspect this entity. A definitive diagnosis can be made by other physiologic, roentgenographic, and endoscopic procedures. A special pulmonary function test known as the flow-volume loop may be the most desirable of these procedures. It is a safe, accurate, and inexpensive method of diagnosing occult upper airway obstruction.

Case report

A 36-year-old woman who had smoked 1½ packs of cigarettes daily for 18 years had a 4-month history of suspected bronchial asthma. During that time she had experienced occasional episodes of wheezing and dyspnea at times associated with coughing and hoarseness. Exertion was a definite precipitating factor, although symptoms sometimes occurred at rest. The symptoms were increasing in frequency and intensity, and her exercise tolerance had diminished.

One month before, a diagnosis of bronchial asthma had been made and therapy with ephedrine sulfate, theophylline, and hydroxyzine hydrochloride (Marax) and tetracycline was instituted. She obtained partial relief, but an exacerbation resulted in her going to the local emergency room; subcutaneous epinephrine provided some relief of symptoms.

She had been seen one week previously for follow-up of acute myelocytic leukemia. Her respiratory symptoms had increased after recent chemotherapy with vincristine, adenine arabinoside (Ara-A), and a tapering course of prednisone. Bilateral inspiratory and . . .



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