![]() The final diagnosis was uncontrolled bronchial asthma, pulmonary emphysema, diffuse bronchiectasis, and gastroesophageal reflux disease (GERD). Her electrocardiogram was normal, and the results of the microbiological study of sputum were negative. The patient had a negative bronchodilator response (Table 1). Respiratory function test results revealed moderately severe obstructive lung disease accompanied by inflation, moderately reduced alveolar-capillary diffusion, and mild type I respiratory failure. Immunoglobulin quantification showed an increase in total IgE levels (671 IU/mL), with no other abnormalities. Examination of the abdomen and limbs revealed no abnormalities.Īn HRCT scan showed centrilobular and paraseptal emphysema, cylindrical bronchiectasis (predominantly central and upper lobe bronchiectasis), and two micronodules of 3 mm and 4 mm in diameter, respectively, in the right lower lobe and in the left lower lobe (Figure 1). Pulmonary auscultation revealed diminished breath sounds at both lung bases and increased expiratory time. Physical examination revealed good general health and normal vital signs, with no signs of breathlessness. She also reported no contact with individuals with communicable diseases. In addition, she reported no contact with animals or recent trips abroad. She reported no occupational or domestic exposure to inhaled pollutants. Since her hospitalization, the patient had been receiving the salmeterol-fluticasone combination, tiotropium, aminophylline, and rescue albuterol. She had a history of bronchial asthma since childhood and of allergy to dust mites, as well as having pulmonary emphysema (diagnosed at age 49 years) and hiatal hernia. The patient had been a smoker since she was 16 years old (smoking history, 30 pack-years). The patient also complained of hypopharyngeal pain when using inhalers, as well as experiencing retrosternal burning after meals. However, she still complained of dyspnea on moderate exertion and occasional nocturnal wheezing. The patient responded well to treatment and was therefore discharged. More recently, she had been hospitalized for community-acquired pneumonia and exacerbation of bronchial asthma. The patient had remained asymptomatic until 7 years prior, when she began to have episodes of dyspnea, wheezing, and productive cough, which prompted repeated emergency room visits. She reported having bronchial asthma since childhood, having been treated by a pulmonologist until age 40 years. We have recently treated a 60-year-old female patient who was a college professor.
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