Syncope in an Adult With Uncontrolled Asthma

Thomas J. Beckman, MD

Disclosures

South Med J. 2002;95(3) 

In This Article

Abstract and Introduction

Cough syncope occurs primarily in middle-aged male smokers with chronic obstructive pulmonary disease (COPD). It has also been described in children with asthma. I report the case of a 34-year-old nonsmoker who had syncope due to coughing, and who also related a 1-year history of cough with wheezing. Chest examination revealed diffuse wheezing and a prolonged expiratory phase, and pulmonary function testing with a methacholine challenge confirmed hyperreactive airways. Notably, while undergoing spirometric testing he had a recurrent syncopal episode. His syncope resolved with medical therapy for asthma.

Cough syncope is well recognized in obese, middle-aged men with a history of smoking and chronic obstructive pulmonary disease (COPD). Syncope due to coughing was initially described more than a century ago and has been labeled by nearly 40 synonyms, including laryngeal vertigo, tussive syncope, posttussive syncope, and cough syndrome.[1] Cases of cough-induced syncope in association with asthma are reported primarily in the pediatric literature. Katz[2] described the disorder in 10 asthmatic children, most of whom had bronchospasm demonstrated by reversibility on pulmonary function testing. Another study reported 12 cases, all involving children with known asthma and typical cough syncope; most of them had complete resolution of syncope after aggressive treatment for asthma.[3] The extent of this disorder among young adult asthmatics is unknown, and it may be underrecognized in this population.

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