| Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels. | |
| | |
MedLine Citation:
|
PMID: 21364311 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
Background: Despite the fact that bronchioles are involved in asthma, there have been limited asthmatic cases showing marked centrilobular opacities on computed tomography (CT) chest scans. Systemic corticosteroids have been administered in such cases, but the efficacy of extra-fine particle inhaled corticosteroids has not been assessed. Case Summary: A previously healthy 64-year-old man presented with a four-month history of productive cough and progressive dyspnea despite a combination therapy with inhaled salmeterol (50μg bid) and fluticasone (500μg bid), sustained-release theophylline, and pranlukast because of suspicion of asthma. Physical examination revealed wheezing at the end of forced expiration. High resolution CT chest scan showed diffuse centrilobular opacities, bronchiectatic changes, and bronchial wall thickening. Transbronchial lung biopsy, bronchoalveolar lavage fluid, and transbronchial biopsy all showed predominant eosinophil infiltrates, suggesting that eosinophilic inflammation across the entire airway tree caused the abnormal CT findings. Alveolar fraction of exhaled nitric oxide level, a non-invasive marker of eosinophilic peripheral airway inflammation, was also elevated. Because he refused systemic corticosteroids, inhaled ciclesonide (400μg bid) and inhaled tiotropium were added on to his current medication under careful observation. His symptoms, pulmonary function and CT findings promptly improved, and he had fully recovered at follow-up. Discussion: Extra-fine particle inhaled corticosteroids could be an alternative approach in centrilobular opacities caused by eosinophilic peripheral airway inflammation. |
| | |
Authors:
|
Hirofumi Kiyokawa; Hisako Matsumoto; Hitoshi Nakaji; Akio Niimi; Isao Ito; Kikuko Ono; Tomoshi Takeda; Tsuyoshi Oguma; Kojiro Otsuka; Michiaki Mishima |
Publication Detail:
|
Type: JOURNAL ARTICLE Date: 2011-2-25 |
Journal Detail:
|
Title: Allergology international : official journal of the Japanese Society of Allergology Volume: - ISSN: 1440-1592 ISO Abbreviation: - Publication Date: 2011 Feb |
Date Detail:
|
Created Date: 2011-3-2 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9616296 Medline TA: Allergol Int Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
|
Department of Respiratory Medicine, Kyoto University, Kyoto, Japan. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Four Cases of Atopic Dermatitis Complicated by Sjögren's Syndrome: Link between Dry Skin and Autoim...
Next Document: Rapid Desensitization with Autologous Sweat in Cholinergic Urticaria.