A Case of Uncontrolled Asthma

Yogarajan R¹, Jayakumari S², Sumathi K³ and Mohan Kumar P R*⁴

Further detailed evaluation of any uncontrolled asthma despite proper treatment is required to evaluate the cause and to provide appropriate treatment.

Abstract

A 50y/o female patient with severe uncontrolled asthma was presented to our hospital for anti-IgE therapy. She complained of persistent dyspnea and wheezing after a severe asthma attack five months before. Her asthma had not been controlled with adequate asthma treatment, including budesonide  + formoterol b.i.d. combination, montelukast at 10 mg/day, and oral steroids (30–40 mg daily of prednisolone), during this period. She was hospitalized for evaluation of anti-IgE therapy. Chest X-ray revealed a left-sided hilar opacity. Fiberoptic bronchoscopy was done and showed an endobronchial lesion obstructing the left lower bronchus lumen. Computed tomography(CT)  revealed a nodular lesion at the same site. The patient has undergone left lower lobe lobectomy and lymph node dissection (mediastinal lymphnode). Pathological examination was done and confirmed the diagnosis of typical carcinoid tumor. After surgery, her symptoms subsided, and she had no recurrence. A diagnosis of severe asthma requires confirmation of asthma to r/o other conditions. Uncontrolled symptoms that linger despite aggressive therapy need proper evaluation to rule out other etiologies, such as a carcinoid tumor, before selecting new treatment options.

References

Dipaolo F, Stull MA. 1993. Bronchial carcinoid presenting as refractory asthma. Am Fam Physician 48:785-789, 1993

https://doi.org/10.1136/thx.48.8.789

Hurt R, Bates M. 1984. Carcinoid tumors of the bronchus: A 33 year experience. Thorax 39:617-623, 1984

https://doi.org/10.1136/thx.39.8.617

Marty HC, Costes V, Pujol LJ. 1995. Carcinoid tumors of the lung: Do atypical features require agressive management? Ann Thorac Surg 59:78-83, 1995

https://doi.org/10.1016/0003-4975(94)00630-P

Schrevens L, Vansteenkiste J, Deneffe G, et al. 2004. Clinical-radiological presentation and outcome of surgically treated pulmonary carcinoid tumors: A long-term single institution experience. Lung Cancer 43:39-45, 2004

https://doi.org/10.1016/j.lungcan.2003.08.017

Turktas H, Mungan D, Uysal MA, et al. 2010. Determinants of asthma control in tertiary level in Turkey: A cross-sectional multicenter survey. J Asthma 47:557-562, 2010

https://doi.org/10.3109/02770901003692777