He had a history of bronchial asthma for more than 10 years, so he thought it was another asthma attack and inhaled “salbutamol and ipratropium” for 3 days. He went to a nearby health center and was treated with cephalosporin antibiotics and aminophylline for 3 days, but the cough and wheezing continued to worsen, so he was referred to our department for further treatment. After detailed medical history and physical examination, I found that Mr. Li’s wheezing attack was different from his previous asthma attacks in three ways: 1. Mr. Li’s previous asthma attacks were usually triggered by cold or inhalation of irritating gases, but there were no obvious triggers before this attack; 2. After drug treatment, Mr. Li’s wheezing did not improve and still worsened progressively. Then Mr. Li was advised to complete bronchoscopy and chest CT examination as soon as possible. The result of bronchoscopy revealed that a cauliflower-like neoplasm was seen in the wall of the patient’s main bronchus, blocking most of the lumen, and the biopsy pathology confirmed that it was squamous carcinoma. Firstly, the clinical symptoms of bronchial asthma and endobronchial tumor are similar, both manifesting as coughing and wheezing, in comparison, asthma is more common and more frequent, and in this case, the patient’s disease duration is short, only 6 days, and there are no cachectic tumor manifestations such as loss of appetite and wasting. Secondly, the primary care physicians did not take a detailed history and physical examination, or were not experienced enough to pay attention to the lack of obvious triggers before Mr. Li’s wheezing attack, and failed to distinguish the patient’s inspiratory dyspnea from the expiratory dyspnea that should be manifested in asthma during physical examination, not realizing that the inspiratory dyspnea was caused by the narrowing of the airway rather than asthma; in addition, the conditions of the primary care hospitals were In addition, the conditions in primary hospitals are limited and there is no bronchoscopy equipment, so when the patient is not well treated, further examination cannot be performed to determine whether the diagnosis is wrong. Although the clinical manifestations of bronchial asthma and endobronchial tumor are similar, they can be distinguished if they are carefully identified. Firstly, the attack of bronchial asthma is mostly related to exposure to cold air, irritating gas, viral upper respiratory tract infection, exercise, etc., while the attack of endobronchial tumor may not have any obvious trigger before the attack. Therefore, for wheezing and dyspnea of unknown origin, when anti-inflammatory and antispasmodic drug treatment is ineffective and inspiratory dyspnea is found on physical examination, the possibility of endobronchial tumor should be considered and bronchoscopy and chest CT examination should be completed as soon as possible to clarify the diagnosis and avoid misdiagnosis. In order to avoid misdiagnosis, patients should be treated promptly and correctly. To improve the prognosis. Related links] What patients need bronchoscopy? 1. Patients with unexplained hemoptysis who need to clarify the site of bleeding and the cause of hemoptysis, or those who need local hemostatic treatment when the cause and lesion site are clear but medical treatment is ineffective or repeated hemoptysis cannot be performed in emergency surgery. 2. Dry cough or wheezing of unknown origin. 3. Unexplained pulmonary atelectasis or pleural effusion. 4. Unexplained paralysis of the recurrent laryngeal nerve and phrenic nerve. 5. X-ray chest film showing block shadow, pulmonary dysplasia, obstructive pneumonia, and suspected lung cancer. 6. “Occult lung cancer” with negative X-ray chest film but positive sputum cytology. 7. Diffuse lesions, isolated nodules or masses of unknown nature, requiring lung tissue to be clamped or needle aspirated for pathological section or cytological examination. 8. Slow absorption or recurrent pneumonia. 9. Need to use double cannula to aspirate or brush the secretions from deep lung fine bronchus for pathogenic culture to avoid oral contamination. 10. For treatment: such as taking bronchial foreign bodies, aspiration and local medication for pulmonary sepsis, aspiration for sputum retention after surgery, radiotherapy and chemotherapy for local lung cancer tumors, interventions such as balloon dilation or stent placement under bronchoscopy.