Advanced Management Strategies in Severe Asthma and COPD (MC)-Case Study in Severe Asthma Khurana

Case Study in Severe Asthma Khurana

Pdf Summary

The case study discusses a 45-year-old Army veteran diagnosed with severe asthma at 35, who experienced significant respiratory challenges after returning from deployment in the Middle East. The patient, who has no history of childhood asthma or tobacco use, endured worsened symptoms due to exposure to burn pits and sandstorms, necessitating an emergency department visit and oral steroids.<br /><br />Upon his return to the U.S., he suffered from persistent cough, shortness of breath, and wheezing despite being on high doses of inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), leukotriene modifiers (LTM), and recently, Anti-IgE therapy. The patient has several comorbidities, including GERD, chronic rhinosinusitis, PTSD, obesity, and moderate obstructive sleep apnea, which remain well-controlled with treatments.<br /><br />Initial evaluations revealed significant allergen sensitivities and moderate eosinophilia. Despite confirmed adherence to the asthma management plan, frequent exacerbations and ongoing sinonasal symptoms led to the need for oral corticosteroids every few months.<br /><br />Further investigations identified pan-sinusitis, prompting endoscopic sinus surgery with initial improvements. Persistent symptoms and a deterioration in mental health prompted a switch to dupilumab, resulting in better asthma control and no exacerbations, though symptoms persisted. A referral to a laryngologist revealed inducible laryngeal obstruction (ILO), contributing to the patient's difficulties. Treatment for ILO, in tandem with previous therapies, led to substantial improvement, reflected in the patient's asthma control test (ACT) scores.<br /><br />This case underscores the complexity of managing severe asthma with multifactorial influences, emphasizing the importance of comprehensive evaluations for successful long-term management.

Keywords

severe asthma

Army veteran

burn pits exposure

respiratory challenges

inhaled corticosteroids

dupilumab

inducible laryngeal obstruction

comorbidities

endoscopic sinus surgery

asthma management