B60-20 Not Every Chronic Cough Is Asthma

Abstract Introduction The most common cause of chronic cough in children is asthma; however, other causes can include foreign body or obstruction. One of the intraparenchymal lesions that can cause obstruction of the bronchi is congenital pulmonary airway malformations (CPAMs) because they have cysts that can grow with time. Case A 6-year-old male presented with chronic cough for two weeks after near choking episode on an almond. Mom was concerned about aspiration but also worried he had asthma because he has a strong family history of asthma. Spirometry noted airways obstruction (FVC z-score 1.43, FEV1 z-score -0.44, FEV1/FVC ratio -2.51). Post bronchodilator testing did have a 43% improvement in FEF25/75 but did not note a bronchodilator response in FEV1 (8% improvement) and did not reverse the obstruction back to normal. Chest x-ray was also obtained to evaluate a potential foreign body and noted air trapping in the left upper lobe on expiratory imaging and a hyperlucency and architectural distortion in the left upper lobe concerning for a cystic lesion. Chest CT was consistent with a CPAM showing a multi-cystic intraparenchymal lesion with 1 large cyst and multiple other smaller cysts including one with an air fluid level. (Figure 1) The largest cyst (2.2 x 2.7 x 2 cm) was adjacent to the left upper lobe bronchi with associated hyperlucency of the left upper lobe consistent with air trapping. There was normal pulmonary vasculature to the area; therefore, sequestration is unlikely. Surgical resection is planned to determine the type of CPAM. He will undergo repeat spirometry once he has healed from his surgery to determine if his airflow obstruction is improved. Clinical Importance While a majority of children with chronic cough have asthma, this case illustrates other structural causes of airflow obstruction such as CPAMs (or foreign bodies). Our patient has a high asthma predictive index increasing his risk of asthma but had atypical signs of irreversible airflow obstruction and a possible history of aspiration that led to further evaluation to discover the CPAM associated with obstruction and air trapping. If patients with asthma are not improving or difficult to control with typical therapies, it is important to consider other differential diagnoses. CPAMs do not typically present with airflow obstruction on pulmonary function testing or CT scan but should be considered in the differential for patients with an irreversible airflow obstruction. This abstract is funded by: None