Introduction. Foreign body aspiration (FBA) is a rare, but potentially life-threatening event occurring most commonly in children and older adults. The clinical presentation of occult FBA in adults is usually subtle, manifesting as chronic cough, wheezing and exertional dyspnea. A delay in diagnosis is not uncommon for weeks, or even months due to subtlety of symptoms. Direct visualization via bronchoscopy continues to be the gold standard for diagnosing and treating FBA. In this report, we present a case of a man treated for five years having difficult-to-treat asthma with unnoticed tooth aspiration. Case outline. A 63-year-old non-smoker male patient was referred to the Clinic of Pulmonology, University Clinical Center of Serbia, with chief complaints of dyspnea and chronic cough over the course of five years. He sought medical help several times and was diagnosed and treated as late-onset bronchial asthma, which failed to improve even with optimized therapy. A high-resolution CT scan was performed, which showed a calcified body in left main bronchus measuring 16x13mm, which was later extracted via flexible bronchoscopy. There was immediate symptom relief after the extraction. Pulmonary function tests after the procedure showed no bronchial obstruction, with negative bronchodilation test. Conclusion. A difficult-to-manage asthma requires a thorough workup to rule out alternative diagnoses. Foreign body aspiration, even though rare occurrence in adults without obvious risk factors, must be considered to prevent long term complications.
Milivojevic et al. (2026) studied this question.