Asthma usually gives the impression of frequent attacks and a wheezing sound when breathing. When asthma is stable, it is like a normal person. Because of this, some atypical asthma falls between the two and is easily overlooked. Patients with atypical asthma have no obvious wheezing symptoms, but only episodes of chest tightness or persistent cough, which are often misdiagnosed and lead to prolonged illness and even miss the best time for treatment. Chest tightness is not necessarily coronary artery disease. 50-year-old Mr. Zhang has had recurrent chest tightness and precordial discomfort for three years, with each episode lasting 10-60 minutes, accompanied by a feeling of breathlessness, without obvious coughing and wheezing. The episodes mostly occurred in the evening and could be relieved on their own. He had no history of chronic bronchitis or smoking. Over the past three years, Mr. Zhang had been to many hospitals and had undergone many tests, none of which revealed any significant abnormalities. He was given various diagnoses: “coronary heart disease”, “myocardial ischemia”, “chest tightness to be investigated” and so on. He has taken a lot of drugs, but the symptoms have not been significantly relieved. Last month, when Mr. Zhang went to the hospital to check his lung function, he was inadvertently found to have moderate obstructive ventilatory dysfunction. When he went to the respiratory medicine department, the doctor finally confirmed that he was suffering from bronchial asthma. Mr. Zhang was puzzled, how could the chest tightness be a lung problem? Stethoscope] Patients with atypical asthma with “chest tightness” as the main symptom are very common in outpatient clinics, and they are usually seen in cardiology and treated as “coronary heart disease” with poor results. These patients should not simply be considered “not sick” or “neurotic”, but should undergo further pulmonary function tests to clarify whether the “chest tightness” is related to atypical asthma. It is important to note that these patients usually present with mild bronchospasm, which is insidious and mild and difficult to detect on routine examination, but progresses progressively. Failure to diagnose early may result in irreversible impairment of lung function. Persistent cough with its root cause in asthma Miss Zhang, 22, has had recurrent coughing episodes for more than a year. Whenever she inhales cold air or irritating gases (e.g. cigarette smoke), she coughs violently. The main manifestation is a dry cough with occasional small amounts of white sputum, without asthma or dyspnea. She had visited several hospitals and had no significant abnormalities in physical examination, blood tests and chest X-ray. Treated according to bronchitis, has taken a variety of antibiotics and cough suppressants, all ineffective. Two weeks ago, Miss Zhang went to the hospital again, the doctor repeatedly asked the medical history, found that she was suffering from allergic rhinitis, that she was not suffering from a general cough, and suggested that she do a bronchial excitation test. The results confirmed that Miss Zhang was suffering from cough variant asthma – a kind of asthma with chronic cough as the main manifestation! Ms. Zhang wondered: How did her cough become asthma? However, to her surprise, after using inhaled bronchodilators and corticosteroids, her cough symptoms were significantly relieved. Stethoscope] This patient had “cough variant asthma”, the most common type of atypical asthma. It is characterized by a persistent, irritating dry cough without wheezing and dyspnea, and can occur at any age. Due to the lack of typical asthma signs and symptoms, it is easily misdiagnosed as “bronchitis”. In recent years, as asthma has been studied more and more, it is now recognized that the essence of asthma is airway hyperresponsiveness caused by non-specific inflammation of the airways. This airway hyperresponsiveness leads to bronchoconstriction and stimulates cough receptors, resulting in the onset of cough. When bronchial smooth muscle constriction is not severe and airflow obstruction is not significant, there can be no significant wheezing symptoms. However, the patient may experience bronchial irritation, which manifests itself as a recurrent cough that remains untreated for a long time. In short, cough variant asthma and asthma are different clinical manifestations of the same disease, and asthma variant asthma is an early manifestation of asthma. Wheezing is not the only manifestation of asthma The clinical manifestations of atypical asthma are varied and patients are often misdiagnosed as bronchitis, pneumonia, upper respiratory tract infection, coronary heart disease, angina pectoris, neurosis and other diseases. The possibility of atypical asthma should be thought of when there are long-term recurrent episodes of cough and chest tightness with no significant effect by conventional treatment. Tests such as bronchodilator test or airway provocation test can help clarify the diagnosis.