Published online December 31, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. 221 (doi:10.1542/peds.2007-3045)

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LETTER TO THE EDITOR

Pseudo-asthma Revisited

Ran D. Anbar, MD
Division of Pediatric Pulmonology
Upstate Medical University
State University of New York
Syracuse, NY 13210

To the Editor.—

Weinberger and Abu-Hasan¹ are to be commended for highlighting that cough, wheezing, and dyspnea sometimes are misdiagnosed as being attributable to asthma. As illustrated in their article, the cause of such symptoms varies from other physical illnesses such as cystic fibrosis, immotile cilia syndrome, and anatomic airway abnormalities to illnesses that have a primary psychological trigger, such as habit-cough syndrome, vocal cord dysfunction, and anxiety. It should be noted that the latter 3 diagnoses with psychological triggers were documented in a previous report to occur in 21% to 26% of patients aged 6 to 18 years who were referred to a pediatric pulmonary center with a diagnosis of asthma.² On the other hand, in our experience, cystic fibrosis, immotile cilia syndrome, and airway abnormalities are found much less frequently in patients who have been misdiagnosed with asthma.

Given the psychological basis of symptoms for many children who present with respiratory symptoms, many of them benefit from instruction in self-hypnosis.³ For example, >77% of patients with habit cough, vocal cord dysfunction, and anxiety improve with use of self-hypnosis.³ There is an important distinction between self-hypnosis for habit cough⁴ and suggestion therapy, as described by Weinberger and Abu-Hasan.¹ Although suggestion therapy contains hypnotic elements, it relies on a therapist's active involvement throughout the treatment. On the other hand, once instructed in self-hypnosis, children can use it on their own, whenever needed. Thus, self-hypnosis has been used successfully in the treatment of dyspnea resulting from apparent vocal cord dysfunction, even while children have been engaged in exercise,⁵ which obviated the need for other therapy such as use of an anticholinergic aerosol.

Finally, clinicians should keep in mind that patients with asthma are also at risk of symptoms from concomitant psychological issues.⁶ In other words, pseudo-asthma can complicate the presentation of asthma. For example, almost half of patients with asthma may have clinically significant anxiety, which can cause dyspnea.⁷ In another report, almost one quarter of the patients diagnosed with vocal cord dysfunction had concomitant asthma.⁸ Thus, patients with asthma can use self-hypnosis to improve psychological components of their symptoms, which can greatly simplify their medical management.

REFERENCES

1. Weinberger MM, Abu-Hasan M. Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma. Pediatrics. 2007;120 :855 –864[Abstract/Free Full Text]
2. Anbar RD, Geisler SC. Identification of children who may benefit from self-hypnosis at a pediatric pulmonary center. BMC Pediatr. 2005;5 :6 . Available at: www.biomedcentral.com/content/pdf/1471-2431-5-6.pdf. Accessed November 6, 2007[CrossRef][Medline]
3. Anbar RD. Hypnosis in pediatrics: applications at a pediatric pulmonary center. BMC Pediatr. 2002;2 :11 . Available at: www.biomedcentral.com/content/pdf/1471-2431-2-11.pdf. Accessed November 6, 2007[CrossRef][Medline]
4. Anbar RD, Hall HR. Childhood habit cough treated with self-hypnosis. J Pediatr. 2004;144 :213 –217[CrossRef][Web of Science][Medline]
5. Anbar RD. Self-hypnosis for management of chronic dyspnea in pediatric patients. Pediatrics. 2001;107(2) . Available at: www.pediatrics.org/cgi/content/full/107/2/e21
6. Anbar RD. Self-hypnosis for anxiety associated with severe asthma: a case report. BMC Pediatr. 2003;3 :7 . Available at: www.biomedcentral.com/content/pdf/1471-2431-3-7.pdf. Accessed November 6, 2007[CrossRef][Medline]
7. Ortega AN, Huertas SE, Canino G, Ramirez R, Rubio-Stipec M. Childhood asthma, chronic illness, and psychiatric disorders. J Nerv Ment Dis. 2002;190 :275 –281[CrossRef][Web of Science][Medline]
8. Doshi DR, Weinberger MM. Long-term outcome of vocal cord dysfunction. Ann Allergy Asthma Immunol. 2006;96 :794 –799[Web of Science][Medline]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Anbar, R. D. Search for Related Content PubMed PubMed Citation Articles by Anbar, R. D. Related Collections Genetics & Dysmorphology Social Bookmarking                         What's this?