Clinical Differentiation between Resistant Asthma and Chronic Bronchiolitis: Testing a Practical Approach

Intractable asthma is a challenging clinical problem. this study was conducted todetermine whether a subset of patients with intractable asthma may be misdiagnosed andhave a form of bronchiolitis instead and also to determine the effectiveness of macrolidetherapy in these patients.seventy six patients with intractable asthma were re-treated with recommended maximaldoses of oral prednisolone for 5 days, beclomethasone, cromolyn sodium, salbutamol andipratropium bromide for 30 days. thirty five patients were considered as unresponsive andconstituted the study group. they underwent high-resolution ct (hrct) scan followingwhich they were offered with video-assisted thoracoscopic surgical biopsy. group 1 (n= 27)refused biopsy and each was treated with macrolide therapy, while group 2 (n=8) underwentbiopsy, and then received macrolide therapy. the patients were treated and followed forthree months.the study group consisted of 27 patients, with a mean age of 46.9 ± 11.1 years. themean duration of time between the onset of symptoms and the start of this study was8.1 years. in group 2, no patient had pathologic findings of asthma, and 7/8 had a form ofbronchiolitis. there was significant improvement in dyspnea, cough and pulmonary functionindices at the end of the 3-month in both groups (p(less than)0.001).our results suggest that patients with intractable asthma could be misdiagnosed andsome of them have some forms of chronic bronchiolitis. ve believe that any patient whodoes not respond to standard treatments for intractable asthma should be evaluated withexpiratory hrct; those with significant air trapping should be considered for a course ofmacrolide therapy or biopsy for better identification of the underlying disease.