An enigmatic case of asthma

We report a case of a 47 -years- old female patient who presented with shortness of breath, intermittent chest discomfort, persistent dry cough and peripheral edema. She was overweight (BMI: = 32) and a smoker since she was 20 years old; she the patient was affected with by hypertension and in treatment with ACE-inhibitor. Previous workups include chest imaging, laryngoscopy, spirometry, all of which were unremarkable and also esophagogastroduodenoscopy which that discovered hiatus hernia. During her current evaluation, transthoracic echocardiogram (TTE) showed ventricular hypertrofia without hypocinesia and EcocolorDoppler of the left lower revealed signs of chronic venous insufficiency; we prescribed PPI, sartanic and diuretic in place of ACE-inibitor. A spirometry was ordered again for the patient after 20 days for the persistent dry cough and shortness of breath, which showed a post-bronchodilator improvement in the FEV1 by 21%, strongly suggestive of asthma. The patient was started on pharmacological therapy for severe persistent asthma, which led to symptomatic improvement after 2 months. Spirometric findings, clinical presentation and resolution of symptoms with adequate therapy for asthma suggest that this is a case of cough variant asthma.