Clinical Approach for Differentiation between Asthma and Bronchiolitis

Introduction: Asthma resistant to the usual armamentarium of medications is a challenging clinical problem. This study was conducted to determine whether a subset ofpatients with Intractable asthma may be misdiagnosed and have a form of bronchiolitis instead and also to determine the effectiveness of macrolide therapy in these patients. Materials and Methods: For the purposes of this study, we defined difficult asthma as occurring in patients, who had compatible symptoms (e.g. dyspnea, cough and wheezing) but were resistant to 1) oral steroids 2) bronchodilators and 3) inhaled corticosteroids as treated by their referring physician. Results: The study group consisted of 27 patients, 8 men and 19 women, with a mean age and standard deviation of 46.9 ± 11.1 years (range 24-63 years). The mean duration of time between the onset of symptoms and the start of this study was 8.1 years (range 1.5-23 years). There was significant improvement in all parameters at the end of the 3rd. There was also significant improvement in PFT’s 3 months after treatment in both groups. Conclusion: Our results suggest that patients with Intractable asthma could be misdiagnosed and some of them have some forms of chronic bronchiolitis. We believe that any patient who does not respond to standard treatments for Intractable asthma should be evaluated with expiratory HRCT; those with significant air trapping should be considered for a course of macrolide therapy or biopsy for better identification of the underlying disease.