Differentiating asthma and tracheal stenosis: why confirmation of the diagnosis of asthma should precede treatment

IntroductionAsthma is a common respiratory condition; however, its symptoms often overlap with other diseases, posing diagnostic challenges. Tracheal stenosis, often seen in patients with a history of intubation, can mimic asthma symptoms, leading to misdiagnosis.Case studyThis case study discusses a 58-year-old female with hypertension, type 2 diabetes, and obesity. She was initially treated for presumed asthma for over a year without confirming the diagnosis with pulmonary function tests (PFTs). Despite multiple steroid treatments for exacerbations, her condition deteriorated, leading to hospitalization. During hospitalization, her symptoms were minimally improved with steroid and nebulizer treatments. Examination revealed inspiratory stridor, and a subsequent CT scan identified subglottic tracheal stenosis. Flexible bronchoscopy confirmed the stenosis, successfully treated with balloon dilation. Post-procedure, her PFTs showed mild obstruction without bronchodilator response, her shortness of breath resolved, and her exercise tolerance improved markedly without ongoing asthma treatment.DiscussionAsthma symptoms, including dyspnea, wheezing, cough, and chest tightness, frequently overlap with tracheal stenosis. Early differentiation is crucial to avoid misdiagnosis, reduce unnecessary treatments, and prevent complications. Recognizing risk factors, such as obesity, diabetes, female gender, and prior intubation, and employing diagnostic tools, such as PFTs and CT scan of the neck help diagnose tracheal stenosis. Prompt bronchoscopy and appropriate intervention can dramatically improve patient outcomes.ConclusionThis case underscores the importance of heightened clinical suspicion and comprehensive diagnostic evaluation in patients with persistent treatment-resistant asthma-like symptoms, particularly those with a history of intubation, for timely diagnosis of tracheal stenosis.