Asthmatic Granulomatosis

• DOI: 10.1164/rccm.201203-0476oc
• Publication Date: 2012-07-07T01:20:28Z
• Authors: Sally E. Wenzel; Catherine A. Vitari; Manisha Shende; Diane C. Strollo; Allyson Larkin; Samuel A. Yousem
• Keywords: Hypersensitivity pneumonitis

Rationale: Severe asthma represents 5–10% of all asthma, yet remains problematic and poorly understood. Although it is increasingly recognized as consisting numerous heterogenous phenotypes, their immunopathology, particularly in the distal airways interstitium, described.Objectives: To identify pathobiology atypical difficult asthma.Methods: We report 10 from a total 19 patients (17 women 2 men) meeting severe definitions, requiring daily systemic corticosteroid (CS) use, with inconsistent abnormalities on chest computed tomography scans, who underwent video-assisted thoracoscopic biopsies for further diagnosis management.Measurements Main Results: The pathology cases revealed small airway changes consistent (eosinophilia, goblet cell hyperplasia), but unexpected finding interstitial nonnecrotizing granulomas. These had no evidence hypersensitivity pneumonitis, 70% personal or family history autoimmune-like disease. were treated azathioprine, mycophenolic acid, methotrexate, infliximab. Nine showed decreased CS requirements improved maintained FEV1 despite lower doses. Of remaining nine patients, six manifested asthmatic disease, alone combination alveolar septal mononuclear cells, granulomas, whereas three other pathologic findings (aspiration, pneumonia, thromboemboli).Conclusions: data suggest that subset "asthma" manifests granulomatous pathology, which we term "asthmatic granulomatosis." identification this disease currently requires thorascopic biopsy, alternative approaches to therapy lead improvement outcomes.