Climate Change to Blame in Severe Oral Corticosteroid-Dependent Asthma? A Case Report

BACKGROUND Despite the availability of inhaled corticosteroid and the development of various biological treatment agents, severe asthma patients are still at high risk of recurrent and life-threatening exacerbations, which results in morbidity and mortality. In addition to treatment response variability, incorrect inhaler technique, poor adherence, and major psychological problems, environmental factors such as climate change also are contributory factors for worsen symptoms of asthma and acute exacerbation. We present here, a case of a 63-year-old female patient who had oral corticosteroid-dependent severe asthma and recurrent attacks in spring and autumn. CASE REPORT A 63-year-old Chinese female was diagnosed with asthma when she was 3 years old. During 2007-2011, she was admitted to the hospital once a year because of asthma exacerbation; she was on a regular treatment regimen of inhaled corticosteroids (ICS) plus long-acting beta-agonist (LABA). In October 2018, she was admitted to our Department for aggravating symptoms due to "sudden climate change". She was discharged on tapering doses of oral methylprednisolone from 32 mg once daily, but the reduced methylprednisolone resulted in aggravation of wheezing. However, when the weather warmed up, her symptoms were relieved, and she stopped taking methylprednisolone (after the tapering). CONCLUSIONS This study suggests an association between the common causes of weather changes and acute severe asthma exacerbation. Patients and clinicians should be aware that keeping warm and avoiding exposure to cold air and airborne allergens might reduce the frequency of asthma exacerbations.