A 50-year-old woman was referred to our hospital for further examination of severe constricting
pain at the right-side dominant anterior chest. She had medical history of outgrown childhood
asthma and
allergies to several animals. Chest auscultation revealed no wheezes,
rhonchi and other
crackles. Laboratory findings showed an
eosinophilia and an elevation of total
immunoglobulin E. The results of an electrocardiogram, a chest X-ray and a chest CT were unremarkable. A fractional exhaled
nitric oxide value remarkably elevated, but the abnormalities in pulmonary function test were modest. Her
chest pain was ameliorated after inhaling
procaterol. Based on these findings, a diagnosis of chest tightness variant
asthma was formulated, and we started treatment with inhaled corticosteroid / long acting β2 agonist. At two-weeks
after treatment, her symptom markedly improved and a fractional exhaled
nitric oxide value decreased, which led to a definitive diagnosis of chest tightness variant
asthma. A fractional exhaled
nitric oxide value further decreased to the normal range in consistent with symptom disappearance at 10-months
after treatment, indicating the usefulness of fractional exhaled
nitric oxide as a promising marker for the diagnosis and clinical improvement of chest tightness variant
asthma. J. Med. Invest. 68 : 389-392, August, 2021.