TY - JOUR T1 - Lessons of the month: A breathless severe asthmatic in the genomic era: Occam's razor or Hickam's dictum? JF - Clinical Medicine JO - Clin Med SP - e264 LP - e266 DO - 10.7861/clinmed.2020-0661 VL - 20 IS - 6 AU - Carmen Venegas AU - Sarah Svenningsen AU - Melanie Kjarsgaard AU - Mark Tarnopolsky AU - Kim Anderson AU - Sebastian Levesque AU - Benjamin A Raby AU - Grace Parraga AU - Gerard Cox AU - Parameswaran Nair Y1 - 2020/11/01 UR - http://www.rcpjournals.org/content/20/6/e264.abstract N2 - Breathlessness is a subjective symptom that may stem from a number of pathological and functional aetiologies. Consequently, clinicians are often faced with the challenge of navigating between the tensions of Occam's razor (parsimonious aetiology) or Hickam's dictum (multiple diagnoses). We report a case of a 36-year-old woman with a lifelong history of episodic breathlessness caused at various times by dysfunctions of lung parenchyma (emphysema) and airway smooth muscle (asthma), skeletal muscle (filamin-C fibrillary myopathy) and cardiac muscle (cardiomyopathy). We illustrate the utility of the modern diagnostic toolbox in the assessment, understanding and management of complex dyspnoea (including the use of inflammometry, inhaled-gas magnetic resonance imaging-guided bronchial thermoplasty, and genetic testing), and also demonstrate the importance of interdisciplinary data interpretation in establishing accurate aetiologic diagnoses. ER -