Long-term administration of Clarithromycin for an asthmatic patient with mucosal abnormalities of sinonasal cavity

We experienced a case of 59-year-old woman with intractable asthma, who had aspirin intolerance. Despite various treatments including systemic corticosteroid administration, she was often admitted due to severe asthma attacks. Furthermore, she had allergic rhinitis and sinusitis. Computed tomography (CT) scans of sinonasal cavity revealed marked thickness of nasal mucosa and air-fluid level in maxillary sinuses. Although her asthma symptoms such as wheezing and dyspnea were improved by administration of bronchodilator, systemic corticosteroids and beclomethasone diisoccyanate (BDI) accompanied with spa therapy, her peak expiratory flow (PEF) showed no improvement. After readmission due to asthma attacks, clarithromycin (CAM) administration for sinonasal disorders was started. The PEF value showed marked improvement after starting CAM administration, and pulmonary functions and bronchial hyperresponsiveness were also improved. It is suggested from her clinical course that CAM may have beneficial effects in asthmatic patients with sinonasal disorders.

気管支喘息にアレルギー性鼻炎や副鼻腔炎を合併する症例は頻回に経験される｡副鼻腔炎症状の増悪が喘息症状の増悪を引き起こす症例も存在し,鼻腔･副鼻腔における炎症が気管支喘息の病態と何らかの関係を持っていることが考えられる｡今回,59才の難治性アスピリン喘息症例を呈示する｡副腎皮質ホルモンの全身投与を含めた様々な治療にも関わらず頻回に重篤な喘息発作を呈し,入退院を繰り返している症例である｡アレルギー性鼻炎も合併し,CTでは著明な鼻粘膜肥厚と上顎洞の鏡面形成が認められた｡入院後の投薬や温泉療法によって呼吸困難は改善したが,ピークフロー値は上昇が認められないまま退院となった｡再入院後,副鼻腔炎に対しクラリスリマイシン投与を開始したところ､ピークフロー値は著明に改善を示し,肺機能･気道過敏性も改善した｡この症例のように,鼻腔･副鼻腔疾患を合併する気管支喘息症例に対しては,クラリスロマイシン投与が有効である可能性が考えられた。