Wheeze in the time of COVID-19: overcoming obstacles to an unusual diagnosis

Barclay, Mhairi; Buderi, Silviu; Bush, Andrew; Daniel, Mat; Jordan, Simon; Rice, Alexandra; Ruggins, Nigel; Semple, Thomas; Smyth, Alan Robert

Abstract

This case is an example of a rare cause of a common clinical presentation (persistent lobar collapse with wheeze). We describe patient management from primary care through to a national thoracic referral centre. We highlight the importance of objective testing to support an asthma diagnosis and the need to consider alternative or additional diagnoses if a patient does not respond to treatment or the clinical course is unexpected. We highlight the importance of follow-up X-ray to determine whether atelectasis has resolved, which was significantly delayed in this case due to COVID-19 restrictions. Though rare, an endobronchial tumour should be considered if atelectasis persists and when planning endoscopy for a presumed foreign body, especially if the clinical history and patient factors make a foreign body less likely. Greater awareness of this as a differential may expedite diagnoses for patients in future. We show how virtual, multicentre, multidisciplinary meetings can aid rapid diagnosis, surgical planning and coordination of follow-up across centres.

Citation

Barclay, M., Buderi, S., Bush, A., Daniel, M., Jordan, S., Rice, A., …Smyth, A. R. (2022). Wheeze in the time of COVID-19: overcoming obstacles to an unusual diagnosis. Thorax, 77(10), 1050-1053. https://doi.org/10.1136/thoraxjnl-2021-218526

• Journal Article Type: Article
• Acceptance Date: May 19, 2022
• Online Publication Date: Jun 29, 2022
• Publication Date: 2022-10
• Deposit Date: Jul 15, 2022
• Publicly Available Date: Aug 5, 2022
• Journal: Thorax
• Print ISSN: 0040-6376
• Electronic ISSN: 1468-3296
• Publisher: BMJ
• Peer Reviewed: Peer Reviewed
• Volume: 77
• Issue: 10
• Pages: 1050-1053
• DOI: https://doi.org/10.1136/thoraxjnl-2021-218526
• Keywords: Pulmonary and Respiratory Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/8955366
• Publisher URL: https://thorax.bmj.com/content/early/2022/06/29/thoraxjnl-2021-218526