A case of severe airflow limitation markedly improved by inhalation therapy in non-smoking woman with chronic obstructive pulmonary disease]

A 67-year old woman who had never smoked presented with dyspnea on effort and general fatigue, which had first appeared 4 years ago. She had lived for 35 years with her husband who was a heavy smoker. Chest roentgenogram showed pulmonary over-inflation, but chest CT scans didn't demonstrate emphysematous changes. Neutrophil-dominant sputum cytology, a PaO2 of 69.5 Torr, and combined ventilatory impairment on respiratory function test were revealed. FEV1.0 improved 80 ml after beta2-agonist inhalation. Although the respiratory symptoms were improved by inhaled anti-cholinergic drug, residual volume increased minimally. After the use of inhaled steroid drug (HFA-BDP) and salmeterol, the symptoms and residual volume were markedly improved. One year later, FEV1.0 increased by 450 ml. The low attenuation area detected by CT scans decreased, mainly in the lower lung field. Passive smoking might have contributed to her airflow limitation.