She was first alerted by others who told her that she appeared short of breath and that she had to pause to catch her breath while talking. But she never felt anything like that. Some days ago she had an episode of cough and cold following which she felt more and more tired by the day. She had to rest between doing her chores, and sometimes taking a shower left her drained out.
It was put down to chronic fatigue, but as it began to interfere with her daily activities she came in for a consultation. There were many other conditions which could cause those symptoms including heart disease, sluggish thyroid, neuromuscular disease such as myasthenia gravis, pulmonary hypertension and lung fibrosis among others.
She was on medication for high blood pressure, and that could be a reason also, though she had never smoked cigarettes. Deep exploration of her medical history, and carefully chosen tests revealed that her airways or the little tubes in her lungs through which air flows were blocked. We then tested if the blockage could be reversed, and it turned out to be so.
Working on the hypothesis of asthma, we put her on treatment. She reported feeling much better and having more energy compared with the recent past on follow up.
This is quite an unusual presentation of asthma. Textbooks don’t usually mention it. How did we find out? Ask questions, several of them, and listen. Listen also to what is unsaid, observe the patient, and then do a careful clinical examination. This will give you an idea of the underlying disease which you then substantiate with relevant tests.