Nonorganic “asthma” is another term for nonorganic breathing disorder, tracheal (see that entry for a full definition), a disorder that mimics asthma, but is not asthma.
Nonorganic Breathing Disorder, Tracheal
Nonorganic breathing disorder, tracheal (1 of 2)
Distal trachea, showing the carina (middle arrow), where the trachea (or windpipe) divides into the two mainstem bronchi. The membranous tracheal wall is flexible, and beginning to bulge forward functionally (under patient control).
Nonorganic breathing disorder, tracheal (2 of 2)
On expiration, there is anterior bulging (arrows) of the tracheoesophageal party wall, to the point of largely obstructing the mainstem bronchi. Air moving through this functionally narrowed space can cause wheezing on a non-organic basis. Wheezing will be much louder with auscultation over the manubrium, than on listening in the peripheral lung fields.
Example 2
Nonorganic breathing disorder, tracheal (1 of 2)
View of the distal trachea in a patient with nonorganic “asthma.” An arrow marks the location of the carina; note how, at this moment, the mainstem bronchi to each side are widely opened.
Nonorganic breathing disorder, tracheal (2 of 2)
Wheezing. (Arrow still at the carina.) One can see that the cause of the wheezing is functional manipulation of the distal trachea, in this case mainly the left mainstem bronchus (right of image); hence, the wheezing is louder over the lung on that side than the other side. Also, unlike with true asthma, the wheezing is much louder over the manubrium than either of the peripheral lung fields.
Example 3
Nonorganic breathing disorder, tracheal (1 of 2)
View of the distal trachea at the carina (where the windpipe divides into the right and left mainstem bronchi). Orienting arrow at the base of the carina.
Nonorganic breathing disorder, tracheal (2 of 2)
With exhalation, the tracheoesophageal party wall bulges inward to largely obstruct the right mainstem bronchus. The result is convincing, but nonorganic, wheezing. This is suspected from the patient's affect (e.g., surprising nonchalance and distractibility) and because the wheezes auscultate more loudly over the central chest than in the periphery. (In this slightly closer view, an arrow again indicates the base of the carina.)
