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Physiological Approach to Diagnosis

Edward T. Downing, MD; Sidney S. Braman, MD; Michael J. Fox, MD; William M. Corrao, MD

JAMA. 1982;248(21):2878-2881.

Abstract
Three patients with recurrent emergency room visits and hospitalizations for bronchial asthma are described. Although each patient had respiratory distress associated with wheezing and an apparent response to conventional therapy, other features were inconsistent with the pathophysiology of asthma. These included absence of a significantly elevated alveolar-arterial oxygen tension difference, lack of roentgenographic hyperinflation, and normal small airway function soon after clinical response. Furthermore, bronchial hyperreactivity, a constant feature of asthma, was absent in all patients. Each patient demonstrated wheezing that was self-induced and heard loudest over the neck. Two patients had previous psychiatric illness, one of whom had been hospitalized for factitious fever. We believe that these patients had a form of factitious illness not previously described. Recognition of this syndrome may avoid unnecessary medical care and allow initiation of appropriate psychiatric follow-up.

(JAMA 1982;248:2878-2881)

Author Affiliations
From the Pulmonary Division, Rhode Island Hospital, and the Division of Biological and Medical Sciences, Brown University, Providence.

Footnotes
Reprint requests to Rhode Island Hospital, Pulmonary Division, 593 Eddy St, Providence, RI 02902 (Dr Braman).

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