Case presentation 2 TAC quiz

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Seventy-seven-year-woman presents with noisy breathing with persistent shortness of breath for a year. She was diagnosed late onset non atopic asthma from her primary care physician. Her breathing difficulty is worsen during an episode of viral infection and during supine position. Neither history of chocking of swallowing difficulty was noted. She was treated with inhaled corticosteroid and long acting beta-2 agonist as asthma controller and as needed inhaled short acting beta-2 agonist. However, her shortness of breath and noisy breathing were not improved. Physical examination reveals mild obese habitus. Normal head and neck examination was noted. Inspiratory stridor was detected from chest auscultation. Spirometry (flow volume loop) and chest and neck radiographs were performed.

 asthmaquiz
asthma graph

What is your plan of investigation in this patient? 

  • Flexible bronchoscopy for excluding endobronchial mass
  • Methacholine challenge test
  • MRI or neck
  • Fiber-optic laryngoscopy
  • Echocardiography

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