Tracheobronchomalacia in the patients with treatment-resistant severe asthma: case reports

Case reports Case 1. 70 years old woman, with history of severe persistent asthma for 10 years was referred to our allergy clinic. She could not control her asthma and asthmatic attack always happened at night, so it was worse when she slept. She was treated with fluticasone/salmeterol accuhaler (250/50 mcg) 2 puffs twice daily, montelukast (10 mg), theophylline (200 mg), procaterol (50 mcg) and salbutamal evohaler 2-3 times daily. Pulmonary function test showed moderate restrictive lung disease, FEV1 59%. Additionally, chest CT scans detected collapse of trachea at posterior wall. Afterwards we treated tracheomalacia by continuous positive airway pressure at night. As a result, her asthma symptoms have been improving. Case 2. 72 years old woman, with history of severe persistent asthma for 15 years, was partly controlled (asthma controlled test score 20 and peak expiratory flow rate 180 l/min) with asthma medication such as fluticasone/salmeterol accuhaler (500/50 mcg) 2 puffs twice daily, montelukast (10 mg), theophylline (200 mg), tiotropium (18 mcg), salbutamal evohaler 4-5 times and omalizumab (300 mg) every two weeks. 3 months before investigating this case, her asthma could not be controlled (ACT score 7 and PEFR 100 l/min) despite she was treated by the oral corticosteroid (20 30 mg) every day. Her chest CT scans were normal, but the bronchoscope found bronchomalacia at her right and left bronchus of lower lungs.