Clinical Cases

Bronchial Thermoplasty in Asthma

Case Editor - Judd Flesch

Reviewed By Allergy, Immunology & Inflammation Assembly

Submitted by

Rachel Taliercio, DO

Staff, Respiratory Institute

Cleveland Clinic Foundation

Cleveland, OH

Sumita Khatri

Staff, Respiratory Institute

Co-Director, Asthma Center

Cleveland Clinic Foundation

Cleveland, OH

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History

A 49 year old bank employee and never smoker presents to outpatient clinic for evaluation of asthma. She was first diagnosed with asthma as an adult at the age of 27. Since the diagnosis she has been on maintenance therapy and her asthma was well controlled in her late 20’s and early 30’s. During her mid 30’s her asthma got worse, daily symptoms were more frequent and there was increased use of short acting rescue medication. In her 40’s she started to miss work because of asthma and symptoms from a common cold will now linger for weeks. It is harder for her to identify triggers and her asthma is more unpredictable. She has flares requiring prednisone on average two to three times per year. She was hospitalized for an asthma exacerbation two years ago and her most recent ED visit for asthma was one year ago. She currently has daily symptoms of asthma and wakes up at least twice a night. There is daily use of rescue medication and she is breathless with mild exertion. Current therapy is high dose Advair diskus 500/50 one puff twice daily and Singulair. She was on Xolair therapy for a year and a half with no clinical benefit.

Physical Exam

The patient’s BMI was 34. BP 130/90, pulse 75 beats/minute and oxygen saturation 96% on room air. Nasal mucosa appeared mildly inflamed. Lungs were clear to auscultation and there was no clubbing.

Lab

Spirometry demonstrated a diminished FEV1/FVC ratio of62, FEV1 of 1.63L (56%), and FVC of 2.60 L (70%). On date of initial evaluation, her asthma control test was 7, very poorly controlled.

Question 1

Which of the following are criteria for the diagnosis of severe asthma?

References

  1. Chung KF et al. Eur Respir J 2014; 43: 343-373.
  2. Sheshadri et al. Curr Allergy Asthma Ref (2014) 14:470.
  3. Castro et al. AJRCCM 2010; 181: 116-124.
  4. Wahidi and Kraft. AJRCCM 201; 185: 710-714.