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Canadian Respiratory Journal
Volume 7, Issue 5, Pages 415-418
Case Report

Difficult Asthma: Consider All of the Possibilities

Lisa C Cicutto,1,2,5 Kenneth R Chapman,2,4,5 Dean Chamberlain,3,4,5 and Gregory P Downey2,4,5

1Faculty of Nursing, University of Toronto, Canada
2Division of Respirology, Department of Medicine, University of Toronto, Canada
3Department of Pathobiology and Laboratory Medicine, University of Toronto, Canada
4Faculty of Medicine, University of Toronto, Canada
5the Toronto General and Western Hospitals of the University Health Network, Toronto, Ontario, Canada

Copyright © 2000 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Asthma is a common respiratory disease that can often be managed successfully. However, there are patients that do not respond to the maximum doses of standard therapy and subsequently have a reduced quality of life. Many factors can contribute to a failure to respond to treatment, and a comprehensive approach is important when assessing and evaluating these patients. This report describes a patient referred for 'difficult to control asthma' who had multiple emergency department visits and hospitalizations. In addition to a history of wheezing, spirometry showed impaired flow and vital capacity was reduced. Further investigation showed a normal total lung capacity, and a computed tomography scan revealed main bronchus blockage by a tumour, which was confirmed by bronchoscopy. This led to a surgical resection of a mucoepidermoid carcinoma. This case highlights the need to consider all possibilities during the evaluation of patients with difficult asthma.