Corticosteroid-induced myopathy mimicking therapy-resistant asthma.
BACKGROUND
Therapy-resistant asthma is an important clinical problem. However, before considering asthma truly therapy resistant, it is essential to exclude diagnoses that may masquerade as therapy-resistant asthma, such as vocal cord dysfunction and recurrent aspiration, as well as factors related to loss of asthma control, including poor compliance, exposure to allergens, and sinusitis. Corticosteroid-induced myopathy may be an unrecognized but potentially important consideration in both settings.


OBJECTIVE
To describe a patient with corticosteroid-induced myopathy complicating recurrent exacerbations of asthma, which presented with persistently reduced airflow that mimicked therapy-resistant asthma.


METHODS
A 20-year-old Japanese woman with severe intractable asthma who had a history of near-fatal attacks was admitted with recurrent asthma exacerbations that required long-term systemic corticosteroids.


RESULTS
Wheezing episodes decreased but airflow limitation persisted, which was due to not only uncontrolled asthma but also corticosteroid-induced myopathy. Myopathy prevented the adequate use of inhalers, which in turn complicated the tapering of corticosteroids, leading to a vicious cycle. Careful and gradual reduction of corticosteroid dose, while continuing systemic administration of nonsteroidal antiasthma medications, resulted in a resolution of clinical and electromyographic signs of myopathy and pulmonary function abnormalities.


CONCLUSIONS
Corticosteroid-induced myopathy can masquerade as therapy-resistant asthma and can cause poor asthma control.
Yamaguchi
Masafumi
M
Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Niimi
Akio
A
Minakuchi
Masayoshi
M
Matsumoto
Hisako
H
Shimizu
Koichi
K
Chin
Kazuo
K
Mishima
Michiaki
M
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004351:Drug Resistance; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D009135:Muscular Diseases / Q000139:chemically induced* / Q000175:diagnosis; D010366:Peak Expiratory Flow Rate; D013147:Spirometry
D000305:Adrenal Cortex Hormones; D007073:Immunoglobulin E