Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels
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...
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doaj-5111b986d8184365bab39bff29450e032020-11-24T23:58:50ZengElsevierAllergology International1323-89302011-01-0160338138510.2332/allergolint.10-CR-0251Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide LevelsHirofumi Kiyokawa0Hisako Matsumoto1Hitoshi Nakaji2Akio Niimi3Isao Ito4Kikuko Ono5Tomoshi Takeda6Tsuyoshia Oguma7Kojiro Otsuka8Michiaki Mishima9Department of Respiratory Medicine, Kyoto University, Kyoto, JapanDepartment of Respiratory Medicine, Kyoto University, Kyoto, JapanDepartment of Respiratory Medicine, Kyoto University, Kyoto, JapanDepartment of Respiratory Medicine, Kyoto University, Kyoto, JapanDepartment of Respiratory Medicine, Kyoto University, Kyoto, JapanDepartment of Pediatrics, Kyoto University, Kyoto, Japan.Department of Respiratory Medicine, Kyoto University, Kyoto, JapanDepartment of Respiratory Medicine, Kyoto University, Kyoto, JapanDepartment of Respiratory Medicine, Kyoto University, Kyoto, JapanDepartment of Respiratory Medicine, Kyoto University, Kyoto, JapanBackground: 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. 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 (50 μg bid) and fluticasone (500 μg 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 (400 μg 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. Discussion: Extra-fine particle inhaled corticosteroids could be an alternative approach in centrilobular opacities caused by eosinophilic peripheral airway inflammation.http://www.sciencedirect.com/science/article/pii/S1323893015305414alveolar nitric oxideasthmacentrilobular opacitieseosinophilic bronchiolitisextra-fine particle inhaled corticosteroids |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hirofumi Kiyokawa Hisako Matsumoto Hitoshi Nakaji Akio Niimi Isao Ito Kikuko Ono Tomoshi Takeda Tsuyoshia Oguma Kojiro Otsuka Michiaki Mishima |
spellingShingle |
Hirofumi Kiyokawa Hisako Matsumoto Hitoshi Nakaji Akio Niimi Isao Ito Kikuko Ono Tomoshi Takeda Tsuyoshia Oguma Kojiro Otsuka Michiaki Mishima Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels Allergology International alveolar nitric oxide asthma centrilobular opacities eosinophilic bronchiolitis extra-fine particle inhaled corticosteroids |
author_facet |
Hirofumi Kiyokawa Hisako Matsumoto Hitoshi Nakaji Akio Niimi Isao Ito Kikuko Ono Tomoshi Takeda Tsuyoshia Oguma Kojiro Otsuka Michiaki Mishima |
author_sort |
Hirofumi Kiyokawa |
title |
Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels |
title_short |
Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels |
title_full |
Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels |
title_fullStr |
Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels |
title_full_unstemmed |
Centrilobular Opacities in the Asthmatic Lung Successfully Treated with Inhaled Ciclesonide and Tiotropium: With Assessment of Alveolar Nitric Oxide Levels |
title_sort |
centrilobular opacities in the asthmatic lung successfully treated with inhaled ciclesonide and tiotropium: with assessment of alveolar nitric oxide levels |
publisher |
Elsevier |
series |
Allergology International |
issn |
1323-8930 |
publishDate |
2011-01-01 |
description |
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.
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 (50 μg bid) and fluticasone (500 μg 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 (400 μg 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.
Discussion: Extra-fine particle inhaled corticosteroids could be an alternative approach in centrilobular opacities caused by eosinophilic peripheral airway inflammation. |
topic |
alveolar nitric oxide asthma centrilobular opacities eosinophilic bronchiolitis extra-fine particle inhaled corticosteroids |
url |
http://www.sciencedirect.com/science/article/pii/S1323893015305414 |
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