With the popularization of medical knowledge, when many people experience chest tightness and breathlessness, they think, “Do I have asthma?” Here are a few real cases to analyze: Case 1: A 90-year-old man suddenly developed episodic wheezing (wheezing is unbearable during an attack, and there is a wheezing sound in the throat, and after the symptoms are relieved, it is the same as a good person), and was diagnosed as senile asthma in my clinic. One winter night a few years ago, the old man again developed wheezing, could not lie down while sitting, could not be relieved with asthma relief medication, carried on at home for a day, and went to the emergency room with unbearable wheezing. Based on the patient’s description and past medical history, the emergency room treated the patient for an acute asthma attack, which was ineffective, and diagnosed an acute heart attack through blood tests on the electrocardiogram machine. This elderly man’s wheezing this time was due to acute left heart failure induced by acute heart attack. Analysis: The clinical manifestations of cardiogenic asthma caused by acute left heart failure are very similar to asthma, and both are prone to occur at night, so it is easy to misdiagnose and miss the diagnosis. The treatment measures for bronchial asthma and cardiogenic asthma are completely different, and failure to diagnose in time may be life-threatening. The differentiation of the two diseases is mainly based on history, symptoms, signs and physical and chemical examinations. Asthma patients usually have a history of asthma or allergic rhinitis, while cardiogenic asthma patients usually have a history of heart disease. Elderly people are likely to have both diseases co-existing, which is difficult to determine. Asthma attacks can be treated with bronchodilators, such as salbutamol aerosol (preferred), or oral aminophylline. If the asthma cannot be relieved after a few times of salbutamol aerosol, the patient should be promptly seen by a hospital. Patients with heart disease who suffer from nocturnal wheezing should first take nitroglycerin, and if it does not relieve, they should also seek medical attention. Case 2, a female, 22 years old, chest tightness and breathlessness for a month and a half, consulted in several hospitals, came to the clinic with examination hints: positive for mycoplasma antibodies (a month ago laboratory order, meaning that the patient was infected with mycoplasma, which is a common respiratory germ), electrocardiogram: tachycardia. The patient’s father came to the respiratory clinic because he had a history of asthma, and a negative airway excitation test was performed on the same day to rule out asthma. Following up on the history, the patient had a fever a month and a half ago, followed by chest tightness. The patient was considered to have a high likelihood of myocarditis, and a cardiac enzyme test was done, which confirmed the diagnosis of myocarditis. Analysis: Myocarditis is easily induced in young patients after upper respiratory tract infection, and chest tightness and panic are among the most common symptoms of myocarditis. We are reminded that if chest tightness appears after an external infection, especially a viral infection, we should be alert to the occurrence of myocarditis. Pay attention to rest and drink more water after a cold to promote healing of the cold on the one hand and prevent complications on the other. Case 3: A woman, 30 years old, resigned from her job after giving birth and stayed home with her children. She had chest tightness, insomnia, cough and sore throat repeatedly for two years, and six months ago she had left chest pain and increased sore throat. Through communication with the patient, we analyzed the cause of chest tightness, probably because he had not fully adjusted his mentality after quitting his job to bring up his children, and gave herbal medicine to dredge the liver and strengthen the spleen for treatment, and the symptoms were significantly relieved with one dose of medicine, which was cured after two weeks. Analysis: Some patients with chest tightness do not have organic lesions, that is, they are neither heart disease nor asthma, but they are unhappy and hold their breath because of emotional factors. This kind of case is very common, the patient’s performance varies, but the common point is chest tightness, foreign body feeling in the throat, can’t cough and can’t swallow, the symptoms change with mood fluctuations. The diagnosis of this part of the patient needs to exclude organic lesions, and the treatment is mainly to adjust the emotions and supplement the medication. In short, the appearance of chest tightness and breathlessness is not necessarily asthma, but if it cannot be relieved on its own, it is necessary to seek medical attention for a clear diagnosis.