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

• Published in: Thorax Vol. 77; no. 10; pp. 1050 - 1053
• Main Authors: Barclay, Mhairi, Buderi, Silviu, Bush, Andrew, Daniel, Mat, Jordan, Simon, Rice, Alexandra, Ruggins, Nigel, Semple, Thomas, Smyth, Alan Robert
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Thoracic Society 01.10.2022; BMJ Publishing Group LTD
• Subjects: Asthma; Asthma - diagnosis; Biopsy; Bronchoscopy; Calcification; Case based discussion; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 Testing; Diagnosis, Differential; Fever; Foreign bodies; Foreign Bodies - diagnosis; Histology; Histology/Cytology; Humans; Medical diagnosis; Paediatric asthma; Paediatric Lung Disaese; Pediatrics; Pleural effusion; Primary care; Pulmonary Atelectasis; Rare lung diseases; Severe acute respiratory syndrome coronavirus 2; Thoracic Surgery; Tomography, X-Ray Computed; Transplants & implants; Tumors; Bronchoscopy; COVID-19; Paediatric asthma; Histology/Cytology; Paediatric Lung Disaese; Thoracic Surgery; Rare lung diseases
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thoraxjnl-2021-218526

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.