COEXISTING CENTRAL AIRWAYS OBSTRUCTION IN A PATIENT WITH ALLERGIC-ASTHMA - UNUSUAL SYMPTOMS DUE TO DYSFUNCTIONS IN SEVERAL REGIONS OF THE RESPIRATORY-TRACT

Intermittent symptoms of central airways obstruction in children and a dolescents are rare and may well be confounded with symptoms of bronch ial asthma. We report on a 17 year old male patient with pre-existing allergic asthma who developed a rough in- and expiratory strider,espec ially during exercise and emotional stress. These symptoms showed no r esponse to bronchodilators. Bronchoscopy demonstrated a prolapse of th e arytenoid cartilage into the larynx during inspiration and a collaps e of the aryepiglottic folds during expiration. Forced expiration also caused a subtotal collapse of the distal trachea and the main bronchi . Discussion: This case is an example of the variety of central airway s obstruction that may mimic asthma symptoms, especially in pre-existi ng asthma. It demonstrates the need for further investigation in all c ases with incoherent symptoms to avoid false treatment and chronificat ion. Besides optimizing asthma therapy, management in our case consist ed of breathing exercises and psychological therapy.