Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels
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- Kiyokawa Hirofumi
- Department of Respiratory Medicine, Kyoto University
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- Matsumoto Hisako
- Department of Respiratory Medicine, Kyoto University
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- Nakaji Hitoshi
- Department of Respiratory Medicine, Kyoto University
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- Niimi Akio
- Department of Respiratory Medicine, Kyoto University
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- Ito Isao
- Department of Respiratory Medicine, Kyoto University
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- Ono Kikuko
- Department of Pediatrics, Kyoto University
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- Takeda Tomoshi
- Department of Respiratory Medicine, Kyoto University
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- Oguma Tsuyoshi
- Department of Respiratory Medicine, Kyoto University
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- Otsuka Kojiro
- Department of Respiratory Medicine, Kyoto University
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- Mishima Michiaki
- Department of Respiratory Medicine, Kyoto University
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Background: Despite the fact that bronchioles are involved in asthma, there have been limited asthmatic cases showing marked centrilobular opacities on computed tomography (CT) chest scans. Systemic corticosteroids have been administered in such cases, but the efficacy of extra-fine particle inhaled corticosteroids has not been assessed.<br> Case Summary: A previously healthy 64-year-old man presented with a four-month history of productive cough and progressive dyspnea despite a combination therapy with inhaled salmeterol (50μg bid) and fluticasone (500μg bid), sustained-release theophylline, and pranlukast because of suspicion of asthma. Physical examination revealed wheezing at the end of forced expiration. High resolution CT chest scan showed diffuse centrilobular opacities, bronchiectatic changes, and bronchial wall thickening. Transbronchial lung biopsy, bronchoalveolar lavage fluid, and transbronchial biopsy all showed predominant eosinophil infiltrates, suggesting that eosinophilic inflammation across the entire airway tree caused the abnormal CT findings. Alveolar fraction of exhaled nitric oxide level, a non-invasive marker of eosinophilic peripheral airway inflammation, was also elevated. Because he refused systemic corticosteroids, inhaled ciclesonide (400μg bid) and inhaled tiotropium were added on to his current medication under careful observation. His symptoms, pulmonary function and CT findings promptly improved, and he had fully recovered at follow-up.<br> Discussion: Extra-fine particle inhaled corticosteroids could be an alternative approach in centrilobular opacities caused by eosinophilic peripheral airway inflammation.<br>
収録刊行物
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- Allergology International
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Allergology International 60 (3), 381-385, 2011
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