BMJ  2008;336:521-522 (8 March), doi:10.1136/bmj.39507.500336.80

Letters

Unresponsive asthma

Don’t forget mediastinal masses

The first 150 words of the full text of this article appear below.

O’Carroll et al highlight some of the important issues in childhood asthma unresponsive to simple treatment in primary care.1 However, they omit malignancy from their differential diagnoses, missing an essential learning point—that chest radiography is advised in children failing to respond to simple standard asthma treatment and certainly before starting oral steroids. Chest radiography should also be performed if the diagnosis is uncertain or if asthma symptoms change.2

Rarely, childhood leukaemia or lymphoma presents with symptoms of asthma—progressive airway obstruction secondary to external lymph node compression causes wheeze and shortness of breath. At worst, this proceeds to critical airway compression and respiratory arrest.2 Standard asthma treatment (steps 1 or 2 of the British Thoracic Society’s asthma guidelines)3 may provide a partial clinical response, but deterioration will ensue. At this point, chest radiography, if performed, will show a mediastinal mass.

The National Institute for Health and Clinical Excellence guidelines for referral . . . [Full text of this article]

Matthew J Murray, consultant paediatric haemato-oncologist, James C Nicholson, consultant paediatric oncologist, Donna McShane, consultant respiratory paediatrician

1 Department of Paediatrics, Addenbrooke’s Hospital, Cambridge CB2 0QQ

mjm16@cam.ac.uk


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