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- W2900874963 abstract "Introduction Uncontrolled asthma can have multiple underlying factors that may be related to differential diagnoses, therapy, patient compliance, environmental exposure, or comorbid conditions. We present a case of poorly controlled asthma related to an unsuspected cause. Case Description A 68-year-old female was referred for uncontrolled asthma. She had asthma since childhood, previously controlled, but worsened over the past year with several exacerbations despite compliance with maximal daily therapy including fluticasone furoate/vilanterol 200/25 mcg, montelukast 10mg, theophylline 200 mg BID, prednisone 5 mg, ipratropium-albuterol 0.5-3 mg, and PRN albuterol MDI. She had several emergency department visits and one hospitalization a year ago. Chest CT showed scattered linear and patchy infiltrates, more in the RLL (Fig). During admission, sputum culture revealed Mycobacterium avium complex (MAC) infection and she was started on azithromycin, rifampin, and ethambutol which continued for 12 months with negative cultures. In the interim, she was started on omalizumab 300 mg every four weeks with slight improvement of symptoms, but declining FEV1 down to 0.79L (48% predicted). Only after completion of mycobacterial therapy that she exhibited marked improvement in symptoms with normalization of FEV1 1.66L (100%). Discussion Nontuberculous mycobacteria (NTM) are free living species that are universally prevalent in the environment. They can cause lymphadenitis, skin infection, soft tissue infection, or pulmonary disease, especially in those with underlying lung disease such as asthma, COPD or cystic fibrosis. Among NTM, MAC is the most common cause of pulmonary disease worldwide. This case illustrates an unusual cause of poorly controlled asthma that should be considered in the evaluation of such patients." @default.
- W2900874963 created "2018-11-29" @default.
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- W2900874963 date "2018-11-01" @default.
- W2900874963 modified "2023-09-25" @default.
- W2900874963 title "UNCONTROLLED SEVERE PERSISTENT ASTHMA: MORE THAN MEETS THE EYE" @default.
- W2900874963 doi "https://doi.org/10.1016/j.anai.2018.09.298" @default.
- W2900874963 hasPublicationYear "2018" @default.
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