"Asthma"

February 14, 2020

During my respirology clinic, I had the opportunity to review many bread and butter cases of respirology including asthma and COPD. One of the patients that I saw today was an elderly patient who was referred to us for management of her "asthma" as she was experiencing shortness of breath. She reports a long-standing history of asthma since her childhood, which at some point had resolved and had in the past few years returned. She is a non-smoker. Her pulmonary function test did not show any evidence of obstruction or reversibility with bronchodilators. Instead, it showed evidence of restriction. On clinical exam and review of her chest x-ray, she has significant kyphosis which seems to be a large contributor to her restrictive lung disease. Looking at her CT spine, we were able to see some honeycombing in her lungs, which may suggest some type of interstitial lung disease. As such, decided to send her to get a high-resolution CT scan of her lungs for further work-up.

This encounter reminded me of the importance of getting the proper diagnosis even though a patient may have a clinical history that seems suggestive of asthma. We also recommended that she discontinue her puffers as she does not have any indication for its use and there can be side-effects despite it being considered relatively benign to the general public. She had been prescribed a long-acting cholinergic because at some point she was though to have COPD. A rare but serious side-effect is this is paradoxical bronchospasm. In someone with poor lung function, this can be fatal.

One of the interesting learning points is the option of using Symbicort as a single inhaler for both maintenance and rescue therapy given its fast onset of action (D'Urzo 2006). This may promote better adherence due to the simplicity of using a single inhaler rather than using an additional SABA (e.g. Ventolin) for rescue therapy.


-JT-

Reference(s):

D’Urzo, A. D. (2006). Inhaled Glucocorticosteroid and Long-Acting β 2-Adrenoceptor Agonist Single-Inhaler Combination for Both Maintenance and Rescue Therapy. Treatments in respiratory medicine, 5(6), 385-391.