Right Middle Lobe Collapse Masquerading as Severe Asthma

A 60-year-old male, diagnosed with adult-onset asthma elsewhere, presented to the Outpatient Department (OPD) of a Tertiary Care Teaching Hospital in Uttar Pradesh for a second opinion.He had persistent wheeze and dyspnea for 4 months, which was unresponsive to maximum bronchodilator therapy.His chest X-ray and spirometry were unremarkable.A high-resolution computed tomography (HRCT) of the thorax revealed right middle lobe collapse, prompting diagnostic bronchoscopy.Bronchoscopic examination revealed granulation tissue occluding the opening of the right middle lobe bronchus, beneath which was a betel nut.The granulation tissue was excised using an electrocautery knife and the foreign body was extracted piecemeal with the help of a cryoprobe.The patient had complete resolution of symptoms following the procedure and was eventually weaned off his bronchodilator therapy.This case highlights the importance of thoroughly evaluating a case of difficult-totreat asthma before labeling him as severe asthma, especially when imaging and spirometry are inconsistent with obstructive airway disease.