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To the Editor: In his Clinical Crossroads article, Dr Busse¹ provides a scholarly discussion of problems in the diagnosis and treatment of a patient with severe shortness of breath, nocturnal awakening, and increasing dosage of many medications. However, Busse believes that emotions are only adjuvant to the process and that people with asthma are understandably anxious. The patient in this case had a history of depression and schizoaffective disorder, which may indicate severe psychiatric illness. Current medications included fluoxetine hydrochloride, 20 mg/d, and nortriptyline hydrochloride, 25 mg at bedtime. Although these drugs may be useful for depression (but usually at higher dosages), this regimen is not adequate treatment for schizoaffective disease.

Panic disorder, which frequently causes nocturnal dyspneic episodes, hypochondriasis, the use of multiple medications with a strong dependence on medical attention, and a propensity to attribute exacerbations to environmental fluctuations, may be confused with asthma. That this patient can . . . [Full Text of this Article]

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