The confusion between asthma and subglottic stenosis can cause an adverse event during intubation. A case report
Wheezing and stridor are a frequent reason for consultation, as well as the diagnosis of asthma. Any cases of asthma with failed clinical response to treatment should undergo additional testing leading to differential diagnoses.
This is a case of a 13-year-old girl who underwent corrective surgery of a right tympanic perforation, with a history of difficult to control exercise-induced asthma. At the time of intubation, Cotton’s grade III laryngeal stenosis was identified that required intervention prior to the scheduled procedure. Emphasis shall be placed on the importance of interdisciplinary work when evaluating these patients.
2. Sherman JM, Lowitt S, Sthephenson C, Ironson G. Factors influencing acquired subglottic stenosis in infants. J Pediatr. 1986;109:322-7.
3. Manica D, Schweiger C, Cauduro P, Kuhl G, Antonacci P. Association between length of intubation and subglottic stenosis in children. Laryngoscope. 2013:1049-54.
4. Randolph C. Pediatric exercise-induced broncoconstriction: contemporary developments in epidemiology, pathogenesis, presentation, diagnosis and therapy. Curr Allergy Asthma Rep. 2013;13:662-71.
5. R0ksund OD, HeimdalJH, Olofsson J, Maat RC, Halvorsen T. Larynx during exercise: the unexplored bottleneck of the airways. Eur Arch Otorhinolaryngol. 2015;272:2101-9.
6. Mokoka MC, Ullah K, Curran DR, O'Connor TM. Rare causes of persistent wheeze that mimic poorly controlled asthma. BMJ Case Rep. 2013, http://dx.doi.org/10.1136/bcr-2013-201100.
7. Johnson J, Theurer WA. Stepwise approach to the interpretation of pulmonary function tests. Am Fam Physician. 2014;89:359-66.
8. Modrykamien AM, Gudavalli R, McCarthy K, Liu X, Stoller JK. Detection of upper airway obstruction with spirometry results and the flow-volume loop: a comparison of quantitative and visual inspection criteria. Respir Care. 2009;54:474-9.
9. He X-O, D’Urzo A, Jugovic P, Jhirad R, Sehgal P, Lily E. Differences in spirometry interpretation algorithms: influence on decision making among primary-care physicians. NPJ Prim Care Respir Med. 2015;25:15008.
10. Empey DW. Assessment of upper airway obstruction. Br Med J. 1972;3:503-5.
11. Myer CM III, O'Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol. 1994;103 Pt 1:319-23.
12. British guideline on the management of asthma A national clinical guideline. British Thoracic Society; 2016.
13. Nunn AC, Nouraei SAR, Jeremy P, Sandhu GS, Nouraei SAR. Not always asthma: clinical and legal consequences of delayed diagnosis of laryngotracheal stenosis. Case Rep Otolaryngol. 2014;2014:325048.
14. Nouraei SA, Nouraei SM, Patel A, Murphy K, Giussani DA, Koury EF, et al. Diagnosis of laryngotracheal stenosis from routine pulmonary physiology using the expiratory disproportion index. Laryngoscope. 2013;123:3099-104.