Twin airway abnormalities complicating the management of acute asthma: a case report.

The term 'refractory asthma' includes patients with severe asthma, steroid-dependent and/or resistant asthma, difficult-to-treat asthma and irreversible asthma. In patients with to difficult to treat asthma, exclusion of other causes of persistent wheeze like vocal cord dysfunction, upper airway obstruction and allergic bronchopulmonary aspergillosis is important. Besides, the presence of anatomical abnormalities that could affect effective medication delivery could also result in sub-optimal treatment response. These factors reiterate the need for a rigorous and systematic approach to rule out alternative co-existent diseases or abnormalities in a patient with difficult-to-treat asthma. We hereby report a case of an asthmatic patient with refractory bronchospasm despite optimal treatment, wherein work-up for an additional pathophysiological process aided in successful management of his symptoms.