School of Medicine
Asthma affects nearly 300 million people worldwide, with 250,000 associated deaths annually. An estimated 5%-10% of patients have severe asthma, while only 1%-2% presented with treatment-resistant or refractory asthma. Currently, the endotype of asthma is divided into T-helper type 2 (Th2) high and Th2-low inflammation endotypes. The Th2-high endotype is characterized by eosinophilic asthma, while the Th2-low endotype is associated with neutrophilia and a pauci-granulocytic profile. The Th2-low endotype carries a high resistance to corticosteroid and bronchodilator therapy, and these patients typically have a severe and acute-onset of symptoms. We present a 57-year-old nonsmoking female with recurrent intensive care unit (ICU) admissions for severe acute asthma exacerbations, resistant to bronchodilator and steroid treatment, requiring mechanical ventilation. Currently, the guidelines for treating neutrophil-predominant Th2-low inflammation asthma have not been established. This creates a management dilemma when encountered with such a patient in clinical practice. We aim to propose targeted treatment options for these severe and potentially fatal asthma patients, with reference to current literature.
Digital Commons Citation
Ijaz, Hasnan M.; Chowdhury, Waliul; Lodhi, Muhammad U.; Gulzar, Qamar; and Rahim, Mustafa, "A Case of Persistent Asthma Resistant to Available Treatment Options: Management Dilemma" (2019). Faculty & Staff Scholarship. 2324.
Ijaz H M, Chowdhury W, Lodhi M, et al. (March 06, 2019) A Case of Persistent Asthma Resistant to Available Treatment Options: Management Dilemma. Cureus 11(3): e4194. doi:10.7759/cureus.4194