A Case of Uncontrolled Asthma

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.