This document discusses pseudo-asthma, which are conditions that mimic asthma but are not actually asthma. It describes several conditions that can cause similar symptoms to asthma, such as vocal cord dysfunction, gastroesophageal reflux disease, chronic obstructive pulmonary disease, foreign body aspiration, and psychogenic dyspnea. It provides details on diagnosing and treating these conditions, noting that they are often misdiagnosed as asthma if not properly considered. Proper diagnosis is important because pseudo-asthma will not respond to typical asthma treatment.

1. Pseudo-asthma
Fawzeia Abo Ali
Faculty of Medicine Ain Shams University

2. Asthma is a heterogeneous disorder
with multiple clinical phenotypes.
 any process that increases
airway resistance can cause
similar symptoms and are
often misdiagnosed as asthma.
 A high index of suspicion for
alternative diagnoses must be maintained if:
Symptoms are atypical
 fails to respond to therapy.

3. Pseudo-asthma : A disorder that mimics
asthma but is not asthma.
◄Vocal cord dysfunction
◄GERD
◄COPD
◄Foreign body
◄Exercise induced dyspnea
◄Psychogenic dyspnea(HVS)
◄Sarcoidosis
◄Cystic fibrosis

4. Vocal Cord Dysfunction (VCD)
Paroxysmal adduction of the
vocal cords, resulting in
airway restriction.
Patients commonly report
shortness of breath,
wheezing, and cough, during
exercise or stress.
 Patients are often
misdiagnosed with asthma

5. diagnosis:
larygoscopy

6. The spirometry flow-volume loop

7. treatment:
speech therapy
Psychotherapy.
inhaled anticholinergics.
control irritating factors such as
gastroesophageal reflux and
rhinitis with post-nasal drip.

8. COPD

9. Pseudo-asthma and
gastroesophageal reflux

10. GERD #ASTHMA

11. Pseudo-asthma and GERD:

12. Foreign body aspiration
which should be suspected in any patient
who presents with wheezing of sudden
onset even in the absence of a clear
history of a choking episode, and in any
child with a unilateral wheeze or unequal
breath sound.
There are occasions where in it might
trigger a generalized irritant response
causing diffuse polyphonic wheezes.

13. the following conditions,
facilitate foreign body aspiration
in adults:
 Impaired swallow reflex
 Impaired cough reflex
 Alcohol or sedative use
 General anathesia
 Dental, pharyngeal procedures
 Loss of consciousness,Convulsions
Frequently aspirated objects
include food (especially nuts and
seeds), teeth, and dental
appliances.

14. Hyperventilation Syndrome

15. Sarcoidosis:

16. CysticFibrosis
 is the second most common chronic inflammatory airway
disease, at least among the white population.
CFT
R

17. Confusing points:
 some people do not present with respiratory
symptoms until adolescence or even adulthood.
 Some degree of bronchodilator response may even
be present.
 Also, asthma can coexist with cystic fibrosis.
 Cystic fibrosis should be suspected when symptoms
and signs of airway inflammatory disease persist
despite a short course of high-dose systemic
corticosteroid.

19. Cardiac asthma
"Cardiac asthma" is a term commonly
used to refer to wheezing associated with
heart failure.
Patients who truly have cardiac asthma
(ie, wheezing with acute heart failure, but
without any other acute pulmonary
pathology) generally respond well to a
combination of bronchodilators,
supplementary oxygen, and treatment of
the heart failure itself .

21. Churge strauss disease
Eosinophilic granulomatosis with polyangiitis (EGPA)

22. WEINBERGER,ABU-HASAN ,PEDIATRICS
Volume120 ,Number4, 2007
◄Exercise induced dyspnea

23. Is it true or pseudo- asthma or?

24. Asthma is more likely Asthma is less likely
More than one of these symptoms:
•wheeze
•breathlessness
•chest tightness
•cough
recurrent or seasonal
History of allergies
Symptoms triggered by exercise,
cold air, irritants
Widespread wheeze
Lower FEV1 or PEF
Eosinophilia or raised
blood IgE level,
Dizziness, light-
headedness,
Isolated cough
Chronic sputum production
clear chest when
symptomatic
Change in voice
Heavy smoker (now or in
past)
Cardiovascular disease
Normal spirometry
or PEF when symptomatic

26. References
 Pseudo-asthma: When Cough, Wheezing, and Dyspnea Are Not Asthma
Miles Weinberger, Mutasim Abu-Hasan
Pediatrics Oct 2007, 120 (4) 855-864; DOI: 10.1542/peds.2007-0078
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