Allergy and Airway |

The Role of VATS in Assessing “Refractory” Asthma FREE TO VIEW

Mark Millard, MD; Sandra Dunn, BS; Grace Hernandez, BS; Laura Blundell, BS; Zlatko Prijic, RRT
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Baylor University Medical Center, Dallas, TX

Chest. 2013;144(4_MeetingAbstracts):74A. doi:10.1378/chest.1704632
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SESSION TITLE: Asthma Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Asthma is a common diagnosis, but may be mimicked by a number of uncommon conditions which can only be diagnosed with a lung biopsy.

METHODS: We looked retrospectively at patients referred to our Center in the last 5 years with refractory asthma or asthma-like symptoms who underwent VATS lung biopsy for ultimate diagnosis, after excluding vocal cord dysfunction.

RESULTS: 19 of 22 were females, with an average age of 54. Prior to biopsy, 10/22 demonstrated restrictive physiology, 3/22 were obstructed, 5/22 showed both obstruction and restriction and 4/22 patients had normal spirometry. 10/22 showed bronchodilator responsiveness, including 4/10 with restrictive physiology. Thin section, high-resolution, non-contrast CT scans revealed relevant abnormalities in all 22 patients including, air-trapping (expiratory view only), ground-glass infiltrates, tree-in-bud pattern or bronchiectasis. Of the 22 VATS procedures performed, the most common diagnosis was either constrictive/obliterative bronchiolitis (9), or hypersensitivity pneumonia (5),followed by follicular bronchiolitis (2), and eosinophilic pneumonia (2). One biopsy showed asthmatic granulomatosis, one sarcoid, one eosinophilic granuloma and only one biopsy revealed airways disease compatible with asthma. Predisposing causes included suspected reflux (14/22) or bird exposure (6/22). 9 of 20 patients responded to therapy, often involving immunosuppressives; 4/20 remained stable.

CONCLUSIONS: A number of respiratory diagnoses can either mimic or accompany athma which may require different therapies and pursue a different natural history than asthma.

CLINICAL IMPLICATIONS: Failure of patients to respond to appropriate interventions to control asthma with trigger assessment, environmental control and step therapy should raise the clinical suspicion that additional/alternative diagnoses may be present which require VATS for confimation but which can respond to therapy.

DISCLOSURE: The following authors have nothing to disclose: Mark Millard, Sandra Dunn, Grace Hernandez, Laura Blundell, Zlatko Prijic

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