Chest
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In patients with a history suggestive of asthma, diagnosis is usually confirmed by spirometry with bronchodilator response (BDR) or confirmatory methacholine challenge testing (MCT). ⋯ In subjects with a self-reported physician diagnosis of asthma, absence of bronchodilator reversibility had a negative predictive value of only 57% to exclude asthma. A finding of spirometric airflow limitation significantly increased chances of asthma. MCT results varied with medication taper and over time, and pulmonologists were sometimes prepared to give a clinical diagnosis of asthma despite negative MCT. Correspondingly, in patients for whom a high clinical suspicion of asthma exists, repeat testing appears to be warranted.
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An 8-year-old boy was referred to our institution because of nausea and vomiting for 1 day. He had also been experiencing shortness of breath for more than 1 year. This symptom had progressed so that he could no longer run or walk upstairs without chest discomfort. ⋯ Echocardiogram 4 years prior suggested mild to moderate biatrial enlargement with trivial mitral valve regurgitation. He did not go in for any follow-up until this admission. He had no other associated diseases, nor use of medicine.
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A 59-year-old woman presented to the ED with syncope. She had progressive shortness of breath with minimal activity and precordial resting chest pain for 1 month prior to presentation. She had a medical history of heart failure with preserved ejection fraction, severe OSA well controlled with CPAP of 11 cm H2O, and a history of DVT and pulmonary embolism, diagnosed 10 years ago for which she was maintained on warfarin. ⋯ The patient had achieved major molecular remission with dasatinib 140 mg daily. Her family history was noncontributory and specifically negative for pulmonary hypertension and heart failure. She had a history of smoking (50 pack years) but had quit 23 years ago.