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PubMed This is a summary of 23 peer-reviewed journal articles Updated
Pulmonology

How Is RP Airway Disease Different From Asthma or Infection?

At a Glance

Relapsing polychondritis airway disease can cause harsh noisy breathing when you breathe in, hoarseness, and breathlessness that may not improve with inhalers. Doctors use breathing tests and dynamic CT scans because asthma or infection can occur at the same time.

In this answer

3 sections

01

Differentiating RP from Asthma and COPD

02

Distinguishing RP from a Chest Infection

03

When to Seek Urgent Medical Care

Relapsing polychondritis (RP) airway disease is frequently mistaken for asthma, chronic obstructive pulmonary disease (COPD), or a chest infection because it causes wheezing, cough, and shortness of breath [1]. However, while asthma and COPD predominantly affect the smaller airways within the lungs, RP often causes inflammation, weakening, and structural damage to the cartilage of the central airways—the larynx (voice box), trachea (windpipe), and main bronchi (large tubes leading to the lungs) [2].

Because RP can coexist with asthma or infections, determining the exact cause of breathing problems requires careful medical evaluation. Bottom Line: If you experience new or rapidly worsening noisy breathing, voice changes, or breathlessness, contact your medical team promptly. Do not try to diagnose the cause at home.

Differentiating RP from Asthma and COPD

Because the symptoms overlap, many people with RP are initially treated for stubborn, treatment-resistant asthma [1]. Your medical team uses several clues to tell them apart, though no single finding is completely diagnostic on its own:

  • Symptom Clues: While asthma often causes a wheeze when you exhale, RP airway disease frequently causes stridor, a harsh, high-pitched whistling sound that is often heard when you breathe in [1][3]. RP can also cause progressive hoarseness (dysphonia) and shortness of breath that worsens with exertion or when changing body positions [4].
  • Response to Inhalers: Asthma involves reversible muscle spasms in the airways that usually improve with bronchodilators (rescue inhalers). In contrast, RP involves structural narrowing, meaning breathlessness from RP typically does not improve as much after using an asthma inhaler [1][5]. However, this is only a clue—if you have both conditions, your inhaler may still provide some relief.
  • Flow-Volume Loops: During a pulmonary function test (spirometry), you blow into a machine that maps your airflow. If you have a central airway obstruction, the test may show a “blunted” or flattened curve [1][5]. This flattening is a non-specific clue that an obstruction exists in the larger airways, prompting further evaluation by a respiratory specialist.
  • Dynamic CT Scans: A standard chest X-ray cannot rule out RP. Doctors often use dynamic expiratory CT scans (images taken while you breathe in and then exhale forcefully) of the neck and chest. In RP, these scans may reveal thickening and calcification of the airway cartilage [6][7]. The scans can also check for tracheobronchomalacia, a condition where the weakened airway walls collapse significantly when you exhale [8][9]. RP inflammation frequently spares the posterior membranous wall (the back part of the windpipe that lacks cartilage), which is another supporting clue for doctors [6][10].

Distinguishing RP from a Chest Infection

Telling an RP flare apart from bronchitis or pneumonia can be difficult because active airway RP can itself cause fever, a productive cough, and elevated inflammatory markers in your blood, such as CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) [11][5][12].

Doctors look for signs that may raise suspicion of an infection, such as localized sounds in the lungs (like crackles heard through a stethoscope) or discolored, purulent mucus [13][14][15]. On a CT scan, infections can produce patterns like fluid-filled lung tissue (consolidation) or “tree-in-bud” opacities (which look like a budding branch on the scan) [16]. However, none of these reliably separates an infection from an RP flare. Clinicians must integrate your physical examination, oxygen levels, imaging, and sputum cultures to make a diagnosis.

It is vital to understand that an infection and RP airway disease can exist at the same time [17][18]. Because RP damages the airways, it makes it harder to clear mucus, increasing your risk of a chest infection. Having a confirmed infection does not rule out the possibility that RP is also causing airway collapse [17].

When to Seek Urgent Medical Care

Because RP can severely narrow the airways or cause them to collapse, it can lead to dangerously low oxygen levels (hypoxemia) and a toxic build-up of carbon dioxide in the blood (hypercapnia) [19][20].

Call emergency services immediately if you experience any of the following signs of a severe or rapidly worsening airway obstruction [21][22]:

  • Blue or gray lips or face
  • Inability to speak in full sentences
  • Severe chest retractions (the skin pulling in around your ribs or neck when you breathe)
  • Confusion, fainting, or severe dizziness
  • An inability to lie flat
  • Sudden, severe breathlessness or rapidly worsening stridor

Do not wait for a pulse oximeter reading to drop before seeking help, as a normal oxygen reading does not rule out rising carbon dioxide levels or a dangerous airway obstruction. If you have prescribed rescue inhalers, you should follow your clinician’s action plan, but do not repeatedly rely on an inhaler or delay calling for emergency care while waiting for it to work [23]. Early medical intervention can protect your airway and prevent a life-threatening crisis.

Common questions in this guide

What features make relapsing polychondritis airway disease different from asthma?
Relapsing polychondritis often narrows or weakens the larger airways and may cause stridor, a harsh sound when breathing in, along with hoarseness or breathlessness that changes with position or exertion. Asthma more commonly causes a wheeze when breathing out and usually improves with a bronchodilator inhaler. The two conditions can occur together, so inhaler response alone cannot establish the diagnosis.
Can a breathing test or CT scan show airway involvement from RP?
A flow-volume loop during pulmonary function testing may show a flattened curve that suggests obstruction in the central airways. Dynamic CT scans of the neck and chest, taken while breathing in and forcefully exhaling, can show airway cartilage changes or collapse called tracheobronchomalacia. A standard chest X-ray cannot rule out RP airway disease.
How can doctors tell an RP flare from bronchitis or pneumonia?
Active airway relapsing polychondritis can cause fever, a mucus-producing cough, and raised inflammation blood tests, so these findings do not prove an infection. Crackles, discolored mucus, or imaging patches of fluid-filled lung tissue may raise suspicion for infection, but no single sign reliably separates the two. Doctors combine the examination, oxygen levels, imaging, and sputum cultures, and may consider that both problems are present.
Can a normal oxygen reading rule out dangerous RP airway narrowing?
No. A normal pulse oximeter reading does not rule out a dangerous obstruction or a rising carbon dioxide level. Seek urgent help for worsening noisy breathing, severe breathlessness, inability to speak normally, confusion, fainting, or other severe warning signs.
When should I call emergency services for RP breathing symptoms?
Call emergency services immediately for blue or gray lips or face, inability to speak in full sentences, severe pulling in around the ribs or neck, confusion, fainting, severe dizziness, inability to lie flat, or sudden severe breathlessness or rapidly worsening stridor. Do not wait for an inhaler to work or for the pulse oximeter to fall before seeking help.
If my inhaler helps, does that rule out RP airway disease?
No. Relief from a rescue inhaler may indicate that asthma is also contributing, but it does not exclude relapsing polychondritis airway disease. Structural narrowing or airway collapse from RP may respond incompletely, and the diagnosis requires clinical assessment and appropriate testing.

Related questions

What Does the RPDAI Mean in Relapsing Polychondritis? What Is the Life Expectancy With Relapsing Polychondritis? Can Relapsing Polychondritis Cause Silent Airway Collapse? What Are the McAdam, Damiani-Levine, and Michet Criteria? Can Relapsing Polychondritis Flare With Normal CRP and ESR?
Show more
What Baseline Tests Are Recommended After RP Diagnosis? How Often Should RP Airway, Heart, Eye, and Hearing Checks? Why Are Biopsy, PET/CT, and Bronchoscopy Used for RP? Why Is RP Diagnosis Delayed? What Records Should I Bring? Can Relapsing Polychondritis Affect One Ear or Area? How Do Doctors Distinguish Active RP From Permanent Damage? How Does RP Affect Anesthesia and Intubation Planning? How Do PFTs and Dynamic CT Diagnose Airway Disease in RP? How Is RP Distinguished From GPA and Ear Infection? Can RP Airway Stents and Tracheostomies Cause Complications? What Are Bronchoscopy Risks in Relapsing Polychondritis? What Causes Relapsing Polychondritis, and Is It Hereditary? What Exercise Is Safe With Relapsing Polychondritis? When Are Airway Procedures Used in Relapsing Polychondritis?

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References

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This page is for informational purposes only and does not replace professional medical advice. It explains clues clinicians may use when evaluating relapsing polychondritis airway symptoms; seek urgent care for severe or rapidly worsening breathing problems.