危及生命的支气管痉挛

J. La-Crette, A. Abdelhamid, A. Chadwick, A. Chakraborty
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引用次数: 0

摘要

摘要虽然嗜酸性粒细胞性哮喘经常诊断不足,但COPD经常被误诊。本病例的重点是COPD的误诊,其后果危及生命。患者是一名59岁的男性吸烟者,在急诊科就诊时有一周的呼吸急促病史。尽管使用了雾化、氧气、类固醇和镁,严重的呼吸性酸中毒仍持续存在。他插管两周,出现严重的支气管痉挛并伴有2型呼吸衰竭。入院时嗜酸性粒细胞明显升高,尽管静脉注射了一周类固醇,但仍然如此。由于他错过了ECMO的窗口期,我们被建议查看他的诊断性肺活量测定。令人惊讶的是,他的全科医生两年前做的肺活量测定显示哮喘而不是COPD。当时他的血液嗜酸性粒细胞也升高了。对嗜酸性粒细胞性哮喘的诊断进行了修订。增加了静脉注射类固醇,并开始雾化使用类固醇。此后不久,他的病情有所好转,从重症监护室出院。希望这份病例报告能增加医生对不同哮喘表型的了解,并减少只有在可避免的危及生命的恶化期间才开始正确治疗的发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Life-Threatening Bronchospasm
Summary While Eosinophilic Asthma is frequently underdiagnosed, COPD is often misdiagnosed. This case focusses on a COPD misdiagnosis that had life-threatening consequences. The patient was a 59-year-old, male smoker, who presented to the Emergency Department with a week's history of increasing shortness of breath. On presentation, severe respiratory acidosis persisted acidotic despite Nebulisers, Oxygen, Steroids, and Magnesium. He was intubated for two weeks and had severe bronchospasm associated with type 2 respiratory failure. Eosinophils on admission were markedly elevated and remained so despite a week of intravenous steroids. As he missed the window for ECMO, we were advised to look at his diagnostic spirometry. Surprisingly, the spirometry done by his general practitioner, two years prior, showed Asthma not COPD. His blood eosinophils were elevated then, too. A revised diagnosis of Eosinophilic Asthma was given. Intravenous steroids were increased, and nebulised steroids were started. Soon thereafter, his condition improved, and he was stepped down from Intensive care. Hopefully, this case report increases physician knowledge of the different Asthma phenotypes and reduces incidences where correct treatment is only started during an avoidable life-threatening exacerbation.
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来源期刊
自引率
0.00%
发文量
16
审稿时长
12 weeks
期刊介绍: JRSM Open is a peer reviewed online-only journal that follows the open-access publishing model. It is a companion journal to the Journal of the Royal Society of Medicine. The journal publishes research papers, research letters, clinical and methodological reviews, and case reports. Our aim is to inform practice and policy making in clinical medicine. The journal has an international and multispecialty readership that includes primary care and public health professionals.
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