Physicians all know what asthma is. is usually often made clinically based on wheezing and shortness of breath but must be confirmed to justify long-term treatment with inhaled steroids with or without long-acting bronchodilators. Self-reported asthma symptoms and even physician-diagnosed “asthma” are more common with obesity but reversible airflow obstruction is not. Case Report Now for the case: Ms X age 57 years transferred her medical care to KP in late December 2009. She was initially seen in main care on January 6 2010 with a diagnosis of steroid-dependent “asthma ” along with obesity depression reflux sleep apnea pollen allergy hypertension hyperlipidemia and prediabetes. She was quickly referred to the Allergy Department where she was initially seen on January 11 2010 She had been taking oral steroids daily since 2003 averaging about 20 mg of prednisone per day. She experienced episodically taken as much as 60 mg/d. Tapering had been tried in the past but was usually halted Zanosar secondary to myalgias shortness of breath and depressive disorder. These symptoms would worsen markedly when dosage reached 10 mg/d. She was a 45-pack-year smoker who quit in 1998. Her shortness of breath did not start until 2002. She underwent environmental skin screening in 2002 and was noted to be allergic to pollens only. She had gained >27 kg in the decade before symptom onset. Her body mass index was 39.6. She underwent sinus surgery in 2003. She experienced no childhood history of asthma and she had not undergone lung function assessments to document reversible airflow obstruction before being seen at KP. She had not undergone a methacholine challenge. She had been getting poor-quality sleep for years. Sleep apnea was initially diagnosed in 2005 and she had been using continuous positive airway pressure (CPAP) when in the beginning seen Rabbit Polyclonal to USP6NL. but she did so irregularly because it did not seem to help. When in the beginning seen in the Allergy Department she had normal spirometry results (forced vital capacity 91 forced expiratory volume in the first second of expiration 96 ratio of forced vital capacity to forced expiratory volume in the first second of expiration 84 without obstruction or restriction. She had a low normal portion of exhaled nitric oxide Zanosar (16 parts per billion). She experienced normal findings on sinus radiographs with no air flow fluid levels. Steroids were in the beginning tapered by 10 mg every other week. The combination steroid and long-acting bronchodilator she had been using was halted. The leukotriene inhibitor she had been given was halted. The angiotensin-converting enzyme (ACE) inhibitor that she had been taking was halted and she was given an angiotensin-receptor blocker instead. Her CPAP machine was retitrated her anti-reflux therapy was reinforced and she began an exercise and weight-loss program. She lost >18 kg by November 2010. When prednisone dosage was down to 10 mg/d the taper was slowed to 1 1 mg every other week. When she caught viral infections the steroid taper was slowed. She Zanosar was no longer taking oral prednisone by early November 2010. Because the individual received help in controlling her weight sleep apnea iatrogenic Zanosar cough and reflux laryngitis her “asthma” symptoms disappeared. She still coughs when she has viral infections but with her assistance and understanding her health care team is usually resisting future long-term treatment with oral steroids. Discussion Physicians learn in medical school that asthma is usually a chronic inflammatory lung disease. It is clinically characterized by shortness of breath and wheezing and physiologically verified by documenting reversible airflow obstruction or bronchial hyperreactivity. We know that there are many other conditions that will cause asthma-like symptoms including obesity heart failure smoking reflux laryngitis viral contamination sinusitis laryngeal dysfunction use of ACE inhibitors and aspiration pneumonia but we still tend to rely on the clinical symptoms Zanosar of coughing wheezing and shortness of breath to diagnose asthma. Asthma treatments are extremely effective in individuals with reversible airflow obstruction caused by small-airway inflammation. Overuse of bronchodilators can contribute to worsening cough laryngitis and reflux. Use of high-dose inhaled steroids increases the risk of diabetes.1 Asthma treatments can seem to provide.