47 year old patient with pseudo-asthma.

A 47yearold female patient presented in out-patient department in Afyon Chest Disease Hospital with dyspnea, cough and purulent sputum. She has been receiving regular inhaler ß-agonist and corticosteroids with the diagnosis of asthma bronchial since childhood. However, the patient had a history of very often upper and lower respiratory tract infections. The patient did not smoke, drink alcohol, or use illicit drugs intravenously. She was currently on asthma medications. On physical examination, the patient has central cyanosis, pretibial edema and her lung sounds were decreased to auscultation bilaterally with deep inspiration. In cardiac auscultation, the heart sounds were heard at the right of sternum and there was splitting in second heart sound (S2). ECG demonstrated sinus tachycardia, inversion of the P and T wave in lead 1 with loss of R wave progression and p pulmonale. In routine complete blood test, the patient had a mild leukocytosis 12000 /μL with % 81 neutrophil, Creactive protein level was 20 mg/dl, erythrocyte sedimentation rate was 56 mm/h. Other parameters were in normal ranges.