title: Coexistence of diffuse panbronchiolitis and asthma: reciprocity of neutrophilic and eosinophilic inflammation.
abstract: Diffuse panbronchiolitis (DPB) and asthma are obstructive airway diseases, the former being characterized by Th1-type and the latter by Th2-type airway inflammation. Differential diagnosis is often a problem, but coexistence has rarely been reported. A 76-year-old man with asthma was admitted to our hospital because of one-month history of dyspnoea on exertion with bilateral diffuse granular shadows. He also had a history of chronic sinusitis. Auscultation of the lungs showed coarse crackles and wheezes. Laboratory data revealed an elevated total serum immunoglobulin E and a high titre of cold agglutinin. Bronchoscopic evaluations of the shadows revealed compatible pathological findings in both DPB and asthma. Low-dose macrolide caused a prompt reduction of symptoms, along with improvements in radiographic findings and pulmonary functions, whereas the eosinophilic airway inflammation transiently worsened. When DPB and asthma coexist, the balance of Th1/Th2 immune response may be reciprocally altered by therapeutic intervention.
authors.affiliation: First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan.
authors.forename: Kiyoshi
authors.identifier: 0000-0002-1734-0031
authors.initials: K
authors.lastname: Takeyama
authors.affiliation: First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Ishii
authors.affiliation: First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Hara
authors.affiliation: First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan.
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Kondo
authors.affiliation: First Department of Medicine Tokyo Women's Medical University School of Medicine Tokyo Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tamaoki
keywords: Chronic sinusitis; FeNO; Th1/Th2; erythromycin; macrolide