A case of difficult asthma

Abstract

Severe asthma, or difficult-to-control asthma is defined as asthma which is not controlled with moderate to high dose of inhaled corticosteroids. Despite the fact that severe asthma only comprises approximately 5% to 10% of all patients with asthma, it accounts for 50% or more of social costs of the disease. Here we presented a case of late onset asthma with high IgE and house dust mite allergy, who had poor asthma control in terms of asthma symptoms, FEV1 and attacks requiring hospital admission, despite high dose inhaled corticosteroid and long-acting beta agonist. Her symptoms and FEV1 improved after a few weeks of additional once-daily Tiotropium Bromide, a long-acting muscarinic antagonist (LAMA), which has been the first-line therapy in patients with COPD. Treatment options of anti-IgE monoclonal antibody and house dust mite immunotherapy are also explored as targeted therapy for this case.