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Case Study:

Shortness of Breath

19-Year-Old College Athlete With a 6-Month History of Shortness of Breath Under Asthma Management*

*The case study presented is for educational purposes only and does not represent a real patient case. Similar results cannot be guaranteed and should not be considered typical.

Role of FeNO

FeNO testing helped identify a nonasthma-related condition with poor response to an inhaled corticosteroid/long-acting beta agonist (ICS/LABA).

Had FeNO been measured at the onset of this patient’s dyspneic symptoms, the symptoms may not have been attributed to a pulmonary inflammatory process. He possibly could have then avoided unnecessary asthma medication trials, chest x-rays, and repeat pulmonary function tests.

Patient Background

  • Reported shallow breathing and sensation of not having a full breath of air on a daily basis
  • No nocturnal symptoms
  • Became acutely short of breath, had perioral cyanosis, and lost consciousness while running on the treadmill for an endurance test 1 week prior to evaluation
  • Previous pulmonary function tests were reportedly normal
  • Patient previously treated with albuterol for exercise-induced bronchospasm
  • History of allergic rhinitis, well controlled with antihistamines
  • Maintained on ICS/LABA to treat continued symptoms

NIOX-Guided Assessment

  • Fractional exhaled nitric oxide (FeNO) level <20 ppb suggested an absence of airway inflammation
  • Repeat pulmonary function testing normal with minimal bronchodilation after albuterol
  • Methacholine challenge negative
  • Possible presence of a condition mimicking asthma, such as vocal cord dysfunction (VCD)

Treatment

  • Stopped treatment for asthma
  • Scheduled follow-up visits at 2 weeks, 6 weeks, and 3 months
  • Prescribed biofeedback training to control VCD and hyperventilation

Follow Up

  • The patient’s episodes resolved, and FeNO remained <20 ppb at each follow-up visit despite the withdrawal of ICS/LABA.