To analyze the clinical characteristics and causes of misdiagnosis of asthmatic patients complained with atypical symptoms and improve the diagnosis and treatment of asthma.

The clinical data of 6 misdiagnosed asthmatic patients with diverse atypical complaints who were treated in outpatient department of respiratory medicine in Changhai Hospital from January 2015 to January 2016 were reviewed retrospectively.The doctor-visiting experience and psychological performance of each patient were introduced by scene reappearance.The clinical features with diagnostic value and the causes of misdiagnosis were summarized.

Six cases with mean age of (41.50±17.50)years old, chiefly complained of cardiac palptations, chest tightness, general malaise, chest pain, throat chokes, chronic cough respectively and showed no typical wheeze sign and no abnormality in their physical examination.One case showed the bilateral bronchial wall thickening in thoracic CT scan, 5 cases had atopic history, 4 cases suffered co-morbidity of allergic rhinitis or eczema, 5 cases got dust mite allegen-positive result through skin prick test.The median value of fractional exhaled nitric oxide (FeNO) was 33.5 ppb(16-176 ppb). Two cases were diagnosed by positive bronchial provocation test and 4 cases were confirmed by variable expiratory airflow limitation.The median course of misdiagnosis was 9 months (3-24 months). All patients were in the mild asthma category and relieved significantly by anti-asthmatic treatment of inhaling corticosteroid and β₂-adrenergic receptor agonist combined with/without leukotriene antagonist.The median onset time was 6 days (2-7 days). The asthma control test (ACT) score after 4 weeks treatment (24.20±1.09) was significantly higher than that before treatment (17.00±1.58; t=8.37, P=0.001).

Asthma patients with atypical chief complaints are mostly accompanied by atopy history and two kinds of typical asthmatic symptoms including chest tightness and shortness of breath.These patients, well responding to regular anti-asthmatic treatment, are easy to be underdiagnosed or misdiagnosed due to the existing of atypical symptoms and heterogeneity in expression from patients.Enhancing the awareness of this heterogeneity, comprehensive medical history collection, utilizing the special auxiliary tests and reasonable empirical treatment are the key measures to make the correct diagnosis timely and effectively.