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Case Report


Severe Asthma Associated With Myasthenia Gravis and Upper Airway Obstruction


A Souza-Machado,1,2 E Ponte,2 ÁA Cruz2

1Pharmacology Department, Bahia School of Medicine and Public Health, Universidade Federal da Bahia, Salvador–Bahia, Brazil
2Asthma and Allergic Rhinitis Control Program (ProAR), Bahia Faculty of Medicine, Universidade Federal da Bahia, Salvador–Bahia, Brazil

J Investig Allergol Clin Immunol 2007; Vol. 17(4): 267-270




An unusual association of asthma and myasthenia gravis (MG) complicated by tracheal stenosis is reported. The patient was a 35-year-old black woman with a history of severe asthma and rhinitis over 30 years. A respiratory tract infection triggered a life-threatening asthma attack whose treatment required orotracheal intubation and mechanical ventilatory support. A few weeks later, tracheal stenosis was diagnosed. Clinical manifestations of MG presented 3 years after her near-fatal asthma attack. Spirometry showed severe obstruction with no response after inhalation of 400 μg of albuterol. Baseline lung function parameters were forced vital capacity, 3.29 L (105% predicted);
forced expiratory volume in 1 second (FEV1), 1.10 L (41% predicted); maximal midexpiratory flow rate, 0.81 L/min (26% predicted). FEV1 after administration of albuterol was 0.87 L (32% predicted). The patient’s flow–volume loops showed flattened inspiratory and expiratory limbs, consistent with fi xed extrathoracic airway obstruction. Chest computed tomography scans showed severe concentric reduction of
the lumen of the upper thoracic trachea.

Key words: Asthma. Tracheal stenosis. Myasthenia gravis. Exacerbation.