Bronchoskopie v rámci diferenciální diagnostiky obtížně léčitelného astmatu
| Title in English | Bronchoscopy in the differential diagnosis of difficult-to-treat asthma |
|---|---|
| Authors | |
| Year of publication | 2014 |
| Type | Article in Periodical |
| Magazine / Source | Studia Pneumologica et Phthiseologica |
| MU Faculty or unit | |
| Citation | |
| Field | Pneumology |
| Keywords | Bronchial asthma; Bronchoscopy; Difficult-to-treat asthma |
| Description | Although bronchial asthma is an incurable condition it responds very well to therapy in most cases. Treatment of asthma patients is aimed at achieving adequate control of the disease. However, there is a group of patients with difflcult-to-treat asthma (DTA) in whom control is neither achieved nor maintained even after 6 months of adequate therapy. In such cases, it is necessary to evaluate patients' adherence to therapy, adequacy of treatment, diagnosis and management of comorbidities potentially aggravating the course of asthma, and, last but not least, confirm the diagnosis of asthma itself. This is where bronchoscopy with bronchoalveolar fluid lavage and tissue sampling for histological examination play an irreplaceable role. The examination is beneficial not only for confirming or excluding the diagnosis of asthma but also for determining the type of asthmatic inflammation (eosinophilic, neutrophilic or paucigranulocytic). In this sequel to a study published in the 5/2012 issue of Studia pneu-mologica et phthiseologica, the authors investigated an extended group of 146 patients with suspected DTA in whom diagnostic bronchoscopy was indicated between 2009 and 2014. Of the entire group of 146 patients, bronchoscopy with histological examination of the tissue samples was diagnostically beneficial in 113 individuals. Alarmingly, of all 113 patients suspected of having DTA and referred to our Center for Difflcult-to-Treat Asthma (most of them receiving the most effective antiasthmatic drugs), the diagnosis of bronchial asthma was confirmed in only 48 %, with the remaining 52 % having difficulties caused by other conditions. From this group of patients, two case reports were selected to illustrate particular patient stories. One is a case of a female patient with a confirmed diagnosis of asthma; the other reports a surprising result of a different diagnosis. |