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Clinical Crossroads Update
July 25, 2001

A 47-Year-Old Woman With Severe Asthma, 1 Year Later

Author Affiliations

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 2001;286(4):457. doi:10.1001/jama.286.4.457

At Medicine Grand Rounds in February 2000, William W. Busse, MD, discussed a 47-year-old woman with severe asthma. Ms A had a history of asthma since childhood. In the previous year, her symptoms had worsened and her medication regimen had been adjusted to reach maximum dosing. Environmental factors, including infestation of mice and cockroaches in her apartment, contributed to her symptoms. Dr Busse discussed genetic and environmental factors related to the increase in the incidence of asthma in the United States. He also discussed the diagnostic approach and presented data on the benefits and effectiveness of various classes of medications. For patients with intractable symptoms, Dr Busse suggested that other causes of shortness of breath should be considered. We asked the patient and her physician to update us on her asthma.