ABSTRACT
A 43-year-old Caucasian female with a confirmed diagnosis of late-onset, corticosteroid-dependent eosinophilic asthma presented to a respiratory outpatient clinic with a five-day history of increasing chest tightness, nocturnal awakening, and exertional dyspnea. Her asthma control questionnaire (ACQ) in the clinic was > 4 and comorbidities included allergic rhinitis, confirmed previously by allergy skin testing that correlated with her exposure history, morbid obesity (BMI 42.2 kg/m2), anxiety disorder, vertebral osteopenia, and vitamin D deficiency. Her treatment regimen included maximal inhaled corticosteroid, a combination of long-acting β-agonist (LABA) and long-acting muscarinic antagonist (LAMA) therapy, modified release aminophylline, and prednisolone 40 mg (increased from a baseline dose of 10 mg, daily). She had been hospitalized once since her previous outpatient consultation for an asthma exacerbation, which required intravenous hydrocortisone, magnesium, and short-acting β-agonist (SABA) nebulizer therapy. Examination revealed widespread, expiratory multiple monophonic wheeze but was otherwise unremarkable. Her peak expiratory flow rate (PEFR) and forced expiratory volume in 1 second (FEV1) were both decreased by 20%. Further enquiry revealed that she had been under considerable stress due to the threat of being fired from her job following repeated absences from work. Notably, her eosinophil count was elevated at 1.3 on the day of her consultation.
