[Asthma of difficult control linked to pulmonary thromboembolism and bronchopulmonary aspergillosis]

Inflammation caused by chronic diseases and the constant use of systemic corticosteroids could be linked to the increased incidence of venous thromboembolic disease.

A 47 year-old man with severe asthma of difficult control and allergic bronchopulmonary aspergillosis who, although the treatment was optimal, continued to have recurrent exacerbations and the need for systemic corticosteroids. He had edema in his left leg. Through venous Doppler ultrasound, deep vein thrombosis was confirmed; because of the images of the pulmonary V/Q gammagram, the presence of chronic pulmonary thromboembolism was suspected. 5 mg of apixaban were prescribed every 12 hours; in less than two months, symptom control was achieved without hospitalization, systemic corticosteroids or short-acting B2 agonists. Gradual withdrawal of omalizumab was started with good tolerance.

The important decrease of bronchial symptoms with the blood thinner confirmed the suspicion that the exacerbations were caused by chronic pulmonary thromboembolism.