title: Difficult asthma: consider all of the possibilities.
abstract: Asthma is a common respiratory disease that can often be managed successfully. However, there are patients that do not respond to the maximum doses of standard therapy and subsequently have a reduced quality of life. Many factors can contribute to a failure to respond to treatment, and a comprehensive approach is important when assessing and evaluating these patients. This report describes a patient referred for 'difficult to control asthma' who had multiple emergency department visits and hospitalizations. In addition to a history of wheezing, spirometry showed impaired flow and vital capacity was reduced. Further investigation showed a normal total lung capacity, and a computed tomography scan revealed main bronchus blockage by a tumour, which was confirmed by bronchoscopy. This led to a surgical resection of a mucoepidermoid carcinoma. This case highlights the need to consider all possibilities during the evaluation of patients with difficult asthma.
authors.affiliation: Toronto Western Hospital, Toronto, Canada. lisa.cicutto@utoronto.ca
authors.forename: L C
authors.initials: LC
authors.lastname: Cicutto
authors.forename: K R
authors.initials: KR
authors.lastname: Chapman
authors.forename: D
authors.initials: D
authors.lastname: Chamberlain
authors.forename: G P
authors.initials: GP
authors.lastname: Downey
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications* / Q000503:physiopathology; D001984:Bronchial Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D018277:Carcinoma, Mucoepidermoid / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D012129:Respiratory Function Tests; D013147:Spirometry