title: Histologic Findings of Severe/Therapy-Resistant Asthma From Video-assisted Thoracoscopic Surgery Biopsies.
abstract: The histologic changes occurring in severe/therapy-resistant asthma (SA) as defined by the European Respiratory Society/American Thoracic Society guidelines, particularly at the level of the distal airways are unknown. This study describes the clinical, radiologic, and histologic characteristics of 29 SA patients who underwent video-assisted thoracoscopic surgery lung biopsy. Pathologic observations were correlated with clinical features, especially the presence of autoimmune disease (AID) (15/29, 51.7%). Ten biopsies (10/29, 34.5%) showed only small airway manifestations of asthma, whereas in 19 (65.5%) asthmatic granulomatosis, manifested by asthmatic bronchiolitis supplemented by an alveolar septal mononuclear infiltrates with non-necrotizing granulomas, was present. SA patients without asthmatic granulomatosis showed more striking small airway injury, subbasement membrane thickening, and neutrophilic infiltrates. Cases with concurrent AID had a tendency to more parenchymal eosinophilic inflammation, more bronchiolocentric granulomas, and a suggestion of increased responsivity to nonsteroidal immunosuppressive therapy. Histologic examination of video-assisted thoracoscopic surgery lung biopsies in SA demonstrates diverse pathologies including cases associated with granulomatous inflammation in addition to eosinophilic infiltrates. This spectrum of histologies may link to a high incidence of AID.
authors.affiliation: Departments of *Pathology ‡Cardiothoracic Surgery, University of Pittsburgh Medical Center †Department of Medicine, Pulmonary Allergy and Critical Care Medicine Division, University of Pittsburgh Asthma Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Humberto E
authors.initials: HE
authors.lastname: Trejo Bittar
authors.forename: Daniel
authors.initials: D
authors.lastname: Doberer
authors.forename: Mitra
authors.initials: M
authors.lastname: Mehrad
authors.forename: Diane C
authors.initials: DC
authors.lastname: Strollo
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Leader
authors.forename: Sally
authors.initials: S
authors.lastname: Wenzel
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Yousem
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications / Q000473:pathology*; D001327:Autoimmune Diseases / Q000150:complications* / Q000453:epidemiology; D001706:Biopsy; D055745:Bronchioles / Q000473:pathology*; D004351:Drug Resistance; D005260:Female; D006099:Granuloma / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D020775:Thoracic Surgery, Video-Assisted