Diagnostic Reevaluation of Persistent Asthma Reveals Underlying Pulmonary Carcinoid Tumor: A Case Report
Yogarajan R 1, Jayakumari S 2, Sumathi K 3, Mohan Kumar P R 4*
Journal of Angiotherapy 6(1) 1-6 https://doi.org/10.25163/angiotherapy.61621762922220122
Submitted: 29 November 2021 Revised: 12 December 2021 Published: 05 January 2022
This case showed the necessity of thorough diagnostic reevaluation in persistent asthma to uncover potential alternative diagnoses like carcinoid tumors.
Abstract
Background: A 50-year-old female patient with severe uncontrolled asthma was presented to our hospital for evaluation of anti-IgE therapy. Despite being on a comprehensive asthma management plan, including budesonide-formoterol combination, montelukast, and oral steroids, her symptoms of persistent dyspnea and wheezing continued unabated following a severe asthma attack five months prior. The case emphasizes the importance of reevaluating uncontrolled asthma to exclude other underlying conditions. Methods: The patient underwent a series of diagnostic evaluations, including chest X-ray, computed tomography (CT), and fiberoptic bronchoscopy. Imaging revealed a left-sided hilar opacity and an endobronchial lesion obstructing the left lower bronchus. The lesion was further assessed via CT, leading to a shift in diagnosis. The patient subsequently underwent a left lower lobe lobectomy and mediastinal lymph node dissection. Results: Pathological examination confirmed the diagnosis of a typical carcinoid tumor. Postoperatively, the patient's symptoms subsided, and she experienced no recurrence. Follow-up assessments indicated improved pulmonary function, and her asthma became well-controlled without the need for further aggressive treatment. Conclusion: This case highlights the need for a thorough evaluation in patients with severe, uncontrolled asthma, particularly when symptoms persist despite aggressive management. Clinicians should consider alternative diagnoses, such as carcinoid tumors, to ensure accurate diagnosis and effective treatment. Early detection and appropriate intervention are crucial in improving outcomes for patients with similar presentations.
Keywords: Uncontrolled asthma, Carcinoid tumor, Diagnostic evaluation, Pulmonary function, Asthma management
References
Agusti, A. G. N., Noguera, A., Sauleda, J., Sala, E., Pons, J., & Busquets, X. (2003). Systemic effects of chronic obstructive pulmonary disease. European Respiratory Journal, 21(2), 347-360. https://doi.org/10.1183/09031936.03.00046702
Bousquet, J., Khaltaev, N., Cruz, A. A., Denburg, J., Fokkens, W. J., Togias, A., ... & Zuberbier, T. (2008). Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA2LEN and AllerGen). Allergy, 63(S86), 8-160. https://doi.org/10.1111/j.1398-9995.2008.01647.x
Busse, W. W., & Lemanske, R. F. (2001). Asthma. The New England Journal of Medicine, 344(5), 350-362. https://doi.org/10.1056/NEJM200102013440507
Castro, M., Zangrilli, J., Wechsler, M. E., Bateman, E. D., Brusselle, G. G., Bardin, P., ... & Newbold, P. (2018). Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: A randomized, phase 3 study. Chest, 153(1), 132-140. https://doi.org/10.1016/j.chest.2017.08.033
Chanez, P., Wenzel, S. E., Anderson, G. P., Anto, J. M., Bel, E. H., Boulet, L. P., ... & Sterk, P. J. (2007). Severe asthma in adults: what are the important questions? The Journal of Allergy and Clinical Immunology, 119(6), 1337-1348. https://doi.org/10.1016/j.jaci.2007.03.046
Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Teague, W. G. (2014). International ERS/ATS guidelines on definition, evaluation, and treatment of severe asthma. The European Respiratory Journal, 43(2), 343-373. https://doi.org/10.1183/09031936.00202013
De Groot, J. C., Storm, H., Veerhoek, D., Bel, E. H., & Ten Brinke, A. (2019). Pathophysiology of bronchiectasis in severe asthma: More than a comorbidity? The Clinical Respiratory Journal, 13(8), 483-490. https://doi.org/10.1111/crj.13053
Dipaolo, F., & Stull, M. A. (1993). Bronchial carcinoid presenting as refractory asthma. American Family Physician, 48(6), 785-789. https://doi.org/10.1136/thx.48.8.789
Durrington, H. J., Farrow, S. N., Loudon, A. S., & Ray, D. W. (2014). The circadian clock and asthma. Thorax, 69(1), 90-92. https://doi.org/10.1136/thoraxjnl-2013-203768
GINA. (2022). Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA). Retrieved from https://ginasthma.org/
Hekking, P. P. W., & Wener, R. R. (2015). The importance of correct asthma diagnosis in patients with persistent symptoms. The European Respiratory Journal, 46(5), 1324-1327. https://doi.org/10.1183/13993003.00471-2015
Humbert, M., Busse, W., Hanania, N. A., Lowe, P. J., Canvin, J., Erpenbeck, V. J., & Holgate, S. (2014). Omalizumab in asthma: An update on recent developments. The Journal of Allergy and Clinical Immunology, 133(2), 546-552. https://doi.org/10.1016/j.jaci.2013.11.007
Hurt, R., & Bates, M. (1984). Carcinoid tumors of the bronchus: A 33-year experience. Thorax, 39(8), 617-623. https://doi.org/10.1136/thx.39.8.617
Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in Microbiology, 4(263), 1-15. https://doi.org/10.3389/fmicb.2013.00263
Lambrecht, B. N., Hammad, H., & Fahy, J. V. (2019). The cytokines of asthma. Immunity, 50(4), 975-991. https://doi.org/10.1016/j.immuni.2019.03.018
Martinez, F. D. (2013). The origins of asthma and chronic obstructive pulmonary disease in early life. Proceedings of the American Thoracic Society, 10(2), 137-141. https://doi.org/10.1513/pats.201208-050MS
Marty, H. C., Costes, V., & Pujol, L. J. (1995). Carcinoid tumors of the lung: Do atypical features require aggressive management? Annals of Thoracic Surgery, 59(1), 78-83. https://doi.org/10.1016/0003-4975(94)00630-P
Masoli, M., Fabian, D., Holt, S., & Beasley, R. (2004). The global burden of asthma: Executive summary of the GINA Dissemination Committee report. Allergy, 59(5), 469-478. https://doi.org/10.1111/j.1398-9995.2004.00526.x
McCracken, J. L., Tripple, J. W., Calhoun, W. J., & Ameredes, B. T. (2017). Diagnosis and management of asthma in adults: A review. JAMA, 318(3), 279-290. https://doi.org/10.1001/jama.2017.8372
National Asthma Education and Prevention Program (NAEPP). (2020). 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. The Journal of Allergy and Clinical Immunology, 146(6), 1217-1270. https://doi.org/10.1016/j.jaci.2020.10.003
Reddel, H. K., & Taylor, D. R. (2017). Asthma control: Still a challenge. The European Respiratory Journal, 50(3), 1701277. https://doi.org/10.1183/13993003.01277-2017
Saito, N., & Kikuchi, T. (2016). An update on the pathophysiology and management of asthma. The Respiratory Medicine Case Reports, 19(12), 64-68. https://doi.org/10.1016/j.rmcr.2016.04.009
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(1), 39-45. https://doi.org/10.1016/j.lungcan.2003.08.017
Turktas, H., Mungan, D., Uysal, M. A., et al. (2010). Determinants of asthma control in tertiary level in Turkey: A cross-sectional multicenter survey. Journal of Asthma, 47(5), 557-562. https://doi.org/10.3109/02770901003692777
Wenzel, S. E. (2012). Asthma phenotypes: The evolution from clinical to molecular approaches. Nature Medicine, 18(5), 716-725. https://doi.org/10.1038/nm.2678
View Dimensions
View Altmetric
Save
Citation
View
Share